Provider Demographics
NPI:1275201881
Name:MCNAMARA, CASEY PATRICK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:PATRICK
Last Name:MCNAMARA
Suffix:
Gender:M
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 1:529 SOUTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WINNEBAGO
Mailing Address - State:MO
Mailing Address - Zip Code:64034-7815
Mailing Address - Country:US
Mailing Address - Phone:816-714-0386
Mailing Address - Fax:
Practice Address - Street 1:529 SOUTHSHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE WINNEBAGO
Practice Address - State:MO
Practice Address - Zip Code:64034-7815
Practice Address - Country:US
Practice Address - Phone:816-714-0386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist