Provider Demographics
NPI:1346867249
Name:BECHTOLD, CASEY M (LMT, MMT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:M
Last Name:BECHTOLD
Suffix:
Gender:F
Credentials:LMT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 STONE CLIFF TRCE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-5397
Mailing Address - Country:US
Mailing Address - Phone:678-617-5701
Mailing Address - Fax:
Practice Address - Street 1:148 STONE CLIFF TRCE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-5397
Practice Address - Country:US
Practice Address - Phone:678-617-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011052225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist