Provider Demographics
NPI:1063763266
Name:CASSELLIUS, NANCY RAE (PTA)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:RAE
Last Name:CASSELLIUS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1169 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-6714
Mailing Address - Country:US
Mailing Address - Phone:715-664-8826
Mailing Address - Fax:
Practice Address - Street 1:N1169 COUNTY ROAD Y
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-6714
Practice Address - Country:US
Practice Address - Phone:715-664-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI337-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant