Provider Demographics
NPI:1962232629
Name:PHAM, CASSIDY JANE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:JANE
Last Name:PHAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 N PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-1647
Mailing Address - Country:US
Mailing Address - Phone:714-640-9491
Mailing Address - Fax:
Practice Address - Street 1:10538 MISSION GORGE RD STE 120
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3154
Practice Address - Country:US
Practice Address - Phone:714-640-9491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist