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General NPI Number Information
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NPI Number | 1275649931
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Entity Type | Individual
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Provider Name | RENEE MARIE CASSIDY IVES PT
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 4815 COOPER RD SUITE 102
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City | BLUE ASH
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State | OH
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Zip | 45242-6993
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Country | US
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Telephone | 513-891-0934
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Fax | 513-891-1323
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Provider Business Mailing Address
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Address Line | 8675 WELLER RD
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City | MONTGOMERY
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State | OH
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Zip | 45249-3422
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Country | US
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Telephone | 504-239-2912
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT011466
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License Number State | OH
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