Provider Demographics
NPI:1366475881
Name:CASEY, KARA J (PT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:J
Last Name:CASEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3866 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2641
Mailing Address - Country:US
Mailing Address - Phone:978-771-6332
Mailing Address - Fax:
Practice Address - Street 1:403 W 5TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4872
Practice Address - Country:US
Practice Address - Phone:760-536-2377
Practice Address - Fax:888-415-0603
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist