Provider Demographics
NPI:1174072789
Name:JESPERSON, CASSANDRA (DPT)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:JESPERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:JESPERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:N7135 HIGH CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-9784
Mailing Address - Country:US
Mailing Address - Phone:920-831-7902
Mailing Address - Fax:
Practice Address - Street 1:10 TRI PARK WAY
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1658
Practice Address - Country:US
Practice Address - Phone:920-831-7902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13545-24261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy