Provider Demographics
NPI:1386917847
Name:WYSOCHANSKI, CASANDRA LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:CASANDRA
Middle Name:LYNN
Last Name:WYSOCHANSKI
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 1:37307 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2809
Mailing Address - Country:US
Mailing Address - Phone:440-865-0580
Mailing Address - Fax:
Practice Address - Street 1:37307 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2809
Practice Address - Country:US
Practice Address - Phone:440-865-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA07550225200000X
AZ9681APTA225200000X
OR8807225200000X
PATE009494225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant