Basic Information
Provider Information
NPI: 1316593080
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASSONE
FirstName: SABRINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 435 HARTFORD TPKE STE U
Address2:  
City: VERNON
State: CT
PostalCode: 060664834
CountryCode: US
TelephoneNumber: 8609791611
FaxNumber: 8602630986
Practice Location
Address1: 1379 ENFIELD ST
Address2:  
City: ENFIELD
State: CT
PostalCode: 060825524
CountryCode: US
TelephoneNumber: 8606982981
FaxNumber: 8606982983
Other Information
ProviderEnumerationDate: 08/17/2019
LastUpdateDate: 08/17/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X012382CTY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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