Provider Demographics
NPI:1295003515
Name:CAISSIE, JO
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:CAISSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30150 PRINCETON CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-8745
Mailing Address - Country:US
Mailing Address - Phone:719-395-8711
Mailing Address - Fax:719-395-9062
Practice Address - Street 1:30150 PRINCETON CIR
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-8745
Practice Address - Country:US
Practice Address - Phone:719-395-8711
Practice Address - Fax:719-395-9062
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist