Healthcare Provider Details

I. General information

NPI: 1174072789
Provider Name (Legal Business Name): CASSANDRA JESPERSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSIE JESPERSON DPT

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TRI PARK WAY
APPLETON WI
54914-1658
US

IV. Provider business mailing address

N7135 HIGH CLIFF RD
MENASHA WI
54952-9784
US

V. Phone/Fax

Practice location:
  • Phone: 920-831-7902
  • Fax:
Mailing address:
  • Phone: 920-831-7902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number13545-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: