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General NPI Number Information
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NPI Number | 1457986754
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Entity Type | Individual
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Provider Name | CASSIDY COONEY PT
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Gender | Male
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Dates
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Enumeration Date | 03/06/2020
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 14557 W INDIAN SCHOOL RD STE 500
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City | GOODYEAR
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State | AZ
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Zip | 85395-9218
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Country | US
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Telephone | 623-242-6908
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Fax |
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Provider Business Mailing Address
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Address Line | 9514 W EL CAMINITO DR
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City | PEORIA
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State | AZ
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Zip | 85345-7738
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Country | US
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Telephone | 602-295-7589
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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 | LPT-31151
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License Number State | AZ
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