Basic Information
| Provider Information | |||||||||
| NPI: | 1811100704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASSELL | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ANTONETTE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 775 HAYWOOD RD # 139 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288063159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287745222 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 775 HAYWOOD RD # 139 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287745222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 11/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 10677 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 250173B | 01 | NC | MEDICARE PROVIDER NUMBER | OTHER |