Provider Demographics
NPI:1104371079
Name:ELSTON, CASEY (PT,DPT)
Entity Type:Individual
Prefix:MISS
First Name:CASEY
Middle Name:
Last Name:ELSTON
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 1:4290 MARLY GARDEN LN APT 304
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-6411
Mailing Address - Country:US
Mailing Address - Phone:716-913-1276
Mailing Address - Fax:
Practice Address - Street 1:44035 RIVERSIDE PKWY STE 500A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8278
Practice Address - Country:US
Practice Address - Phone:703-858-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 040456225100000X
VA23052131102251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics