MEDICARE: MARYANN CASSIDY

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	PTA17054	FL

General Provider Information

NPI Number	:	1538096359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN CASSIDY

Provider Business Mailing Address
First Line	:	4725 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4603
Country	:	US
Telephone Number	:	954-542-5738
Fax Number	:	954-776-3096

Provider Business Practice Location Address
First Line	:	4725 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4603
Country	:	US
Telephone Number	:	954-542-5738
Fax Number	:	954-776-3096

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

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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1942137781 — AMANDA SWISHER
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Directions to “ MARYANN CASSIDY ” Practice Location

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