Provider Demographics
NPI:1730692526
Name:CASSELL, DESIREE (DPT)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:
Last Name:CASSELL
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 1:190 CENTRAL PARK SQ STE 214A
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-4004
Mailing Address - Country:US
Mailing Address - Phone:505-948-4555
Mailing Address - Fax:505-508-1406
Practice Address - Street 1:190 CENTRAL PARK SQ STE 214A
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4004
Practice Address - Country:US
Practice Address - Phone:505-803-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist