Active NPI
Cassidy Bannon, DPT
- Physical Therapist
- Joliet, IL
National Provider Identifier
1154983450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070024353
- Practice address
- 212 Barney Dr
Joliet, IL 60435-5272 - Phone
- (815) 725-2194
- NPI assigned
- Jul 8, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070024353 | IL | Primary |
Addresses
Primary practice location
212 Barney Dr
Joliet, IL 60435-5272
Mailing address
212 Barney Dr
Joliet, IL 60435-5272
Phone (815) 725-2194
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070024353 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bautz Developmental Intervention Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Orland Park, IL
- NPI 1376530055
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562544000000",
"number": "1154983450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 BARNEY DR",
"city": "JOLIET",
"state": "IL",
"postal_code": "604355272",
"telephone_number": "815-725-2194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 BARNEY DR",
"city": "JOLIET",
"state": "IL",
"postal_code": "604355272",
"telephone_number": "815-725-2194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANNON",
"first_name": "CASSIDY",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-08",
"last_updated": "2019-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070024353",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.