MEDICARE: CASSANDRA MARIE KANIA DPT

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	225100000X	Physical Therapist		FL

General Provider Information

NPI Number	:	1578256152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA MARIE KANIA DPT

Provider Business Mailing Address
First Line	:	7902 SAILBOAT KEY BLVD S APT 301
Second Line	:
City	:	SOUTH PASADENA
State	:	FL
Zip	:	33707-6389
Country	:	US
Telephone Number	:	630-486-7617
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 PARK ST N STE 101
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-4030
Country	:	US
Telephone Number	:	727-388-4688
Fax Number	:

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

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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