Provider Demographics
NPI:1275904690
Name:GARTLAND, CASEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GARTLAND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:BOUTILLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:36 POWDERHORN DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4252
Mailing Address - Country:US
Mailing Address - Phone:973-464-0118
Mailing Address - Fax:
Practice Address - Street 1:50 MOUNT PROSPECT AVE STE 207
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1900
Practice Address - Country:US
Practice Address - Phone:201-464-4749
Practice Address - Fax:201-464-4757
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01637500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist