Basic Information
| Provider Information | |||||||||
| NPI: | 1831825058 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CASAZZA | ||||||||
| FirstName: | NICHOLAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 475 ALLENDALE RD STE 206 | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194061495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8623394540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 HAMILTON ST STE 211 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191303814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153830220 | ||||||||
| FaxNumber: | 2153830221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2022 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.