MEDICARE: BETH ANN CASSODY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	928	OK

General Provider Information

NPI Number	:	1083056329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH ANN CASSODY PTA

Provider Business Mailing Address
First Line	:	1414 S DENVER AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-3423
Country	:	US
Telephone Number	:	918-712-7805
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 S DENVER AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-3423
Country	:	US
Telephone Number	:	918-712-7805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	07/29/2013

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