Provider Demographics
NPI:1215065347
Name:CASSADY, ANGELA MARIE (PT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:CASSADY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:OTTOLINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:7524 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5806
Practice Address - Country:US
Practice Address - Phone:832-795-9136
Practice Address - Fax:832-602-2651
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX470445Medicare PIN
TX00636YMedicare PIN
TX471030ZS1KMedicare PIN
TXTXB112114Medicare PIN