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General NPI Number Information
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NPI Number | 1134875222
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Entity Type | Individual
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Provider Name | CASSIDY ANNE HACK PTA
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Gender | Female
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Dates
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Enumeration Date | 02/27/2022
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Last Update Date | 02/27/2022
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Provider Practice Location Address
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Address Line | 717 NEIL AVE
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City | COLUMBUS
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State | OH
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Zip | 43215-1609
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Country | US
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Telephone | 419-612-2649
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Fax |
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Provider Business Mailing Address
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Address Line | 10133 SHERRILL BLVD STE 200
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City | KNOXVILLE
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State | TN
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Zip | 37932-3347
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | PTA012768
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License Number State | OH
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