Provider Demographics
NPI:1164425088
Name:MCGHEE, CASEY B (PT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:B
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:B
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:7580 CLARINGTON CV
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5657
Practice Address - Country:US
Practice Address - Phone:901-641-3000
Practice Address - Fax:901-259-1698
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110318002Medicaid
TN4067711OtherBLUE CROSS
TN620819926OtherCIGNA
TN7122465OtherAETNA
MS7187860Medicaid
AR172494795Medicaid
TN3371161Medicaid
TN620819926OtherTRICARE
TN3645208Medicaid
MS620819926OtherBCBS
TN620819926OtherAETNA
MS06027562Medicaid
TN3645208Medicare PIN
MS7187860Medicaid