Provider Demographics
NPI:1275531667
Name:CASSELMAN, BRAD (MSPT)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:
Last Name:CASSELMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5622 SHERIDAN LAKE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8881
Mailing Address - Country:US
Mailing Address - Phone:605-721-3307
Mailing Address - Fax:605-721-3308
Practice Address - Street 1:520 N CANYON ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2320
Practice Address - Country:US
Practice Address - Phone:605-642-7996
Practice Address - Fax:605-642-5955
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4994698OtherWELLMARK BC/BS
WY118019300Medicaid
SD5833452Medicaid
WY118019300Medicaid
SD4994698OtherWELLMARK BC/BS