Provider Demographics
NPI:1376250712
Name:CASPER, ELISE (LMT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:CASPER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22295 HWY 6 AND 19
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16403-3461
Mailing Address - Country:US
Mailing Address - Phone:814-398-2887
Mailing Address - Fax:814-398-2903
Practice Address - Street 1:22295 HWY 6 AND 19
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:16403-3461
Practice Address - Country:US
Practice Address - Phone:814-398-2887
Practice Address - Fax:814-398-2903
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG007700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist