Provider Demographics
NPI:1366989642
Name:ENGLE, CASSANDRA (DPT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:ENGLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0693
Mailing Address - Country:US
Mailing Address - Phone:585-582-1126
Mailing Address - Fax:888-913-3955
Practice Address - Street 1:490 COLLINS ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-1466
Practice Address - Country:US
Practice Address - Phone:585-226-2480
Practice Address - Fax:585-226-2494
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040480-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist