Provider Demographics
NPI:1992764104
Name:CASSIDY, KEVIN JAMES (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 MENDON HILL LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-5023
Mailing Address - Country:US
Mailing Address - Phone:513-831-5008
Mailing Address - Fax:
Practice Address - Street 1:4358 FERGUSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1680
Practice Address - Country:US
Practice Address - Phone:513-943-4400
Practice Address - Fax:513-943-5323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist