Individual provider Active NPI

Cassandra A. Miller, PT, DPT, OCS

  • Physical Therapist
  • Suffolk, VA
National Provider Identifier
1245648880
Registry record updated Jul 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305208363 Issued in VA
Practice address
5859 Harbour View Blvd Ste 100
Suffolk, VA 23435-3015
Phone
(757) 686-0205
NPI assigned
Jul 28, 2014
Last updated
Jul 9, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305208363 VA Primary

Addresses

Primary practice location

5859 Harbour View Blvd Ste 100
Suffolk, VA 23435-3015

Mailing address

106 W Arden Cir
Norfolk, VA 23505-4828
Phone (518) 461-5515

Other practice location 1

2007 Meade Pkwy
Suffolk, VA 23434-4259
Phone (757) 539-6300

Other identifiers 2

IdentifierTypeStateIssuer
1245648880OtherVAMEDICAID QMB
C05954OtherVAMEDICARE GROUP PTAN

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305208363VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Rehabilitation and Health Services of Virginia, LLC Physical Therapist CurrentSince Aug 31, 2019 Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince Aug 13, 2014 Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince Aug 13, 2014 Accepting new patients
Physiotherapy Associates Inc Past Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients
Physiotherapy Associates Inc Past Accepting new patients

Locations

430 Innovation Dr
Blairsville, PA 15717

2114 Angus Rd
Ste 107
Charlottesvle, VA 22901
Phone (434) 295-4473

10128 W Broad St
Bldg Iii
Glen Allen, VA 23060
Phone (804) 217-9210

2007 Meade Pkwy
Suffolk, VA 23434
Phone (757) 539-6300

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1245648880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 W ARDEN CIR",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054828",
            "telephone_number": "518-461-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5859 HARBOUR VIEW BLVD STE 100",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353015",
            "telephone_number": "757-686-0205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2007 Meade Pkwy",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234344259",
            "country_code": "US",
            "telephone_number": "757-539-6300",
            "fax_number": "757-539-0704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "CASSANDRA",
        "middle_name": "A.",
        "credential": "PT, DPT, OCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-28",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305208363",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID QMB",
            "identifier": "1245648880",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "C05954",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.