Provider Demographics
NPI:1326708520
Name:HUNT, CASEY ALLISON (PTA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ALLISON
Last Name:HUNT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11151 REDBERRY CT
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-8290
Mailing Address - Country:US
Mailing Address - Phone:810-772-8833
Mailing Address - Fax:
Practice Address - Street 1:205 W GRAND RIVER AVE STE 201
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1659
Practice Address - Country:US
Practice Address - Phone:810-588-4133
Practice Address - Fax:810-588-4124
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502006347225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant