Provider Demographics
NPI:1427046762
Name:CASS, SALLY ROBISON
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ROBISON
Last Name:CASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ROBISON
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 N SAN FRANCISCO ST STE B
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4698
Mailing Address - Country:US
Mailing Address - Phone:928-779-6391
Mailing Address - Fax:928-779-6391
Practice Address - Street 1:401 N SAN FRANCISCO ST
Practice Address - Street 2:STE B
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4649
Practice Address - Country:US
Practice Address - Phone:928-773-4840
Practice Address - Fax:928-773-4843
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15872251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ335217Medicaid
AZ6068720001Medicare NSC
S90643Medicare UPIN
AZ335217Medicaid