Provider Demographics
NPI:1003209743
Name:THRUSH, KASEY ALAN
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:ALAN
Last Name:THRUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 E IRVING STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:IL
Mailing Address - Zip Code:60953
Mailing Address - Country:US
Mailing Address - Phone:815-592-4936
Mailing Address - Fax:
Practice Address - Street 1:507 E IRVING ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IL
Practice Address - Zip Code:60953-1141
Practice Address - Country:US
Practice Address - Phone:815-592-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILT620501933102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer