Provider Demographics
NPI:1386004869
Name:KASAI, MICHAEL BRENT (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRENT
Last Name:KASAI
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 3RD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3180
Mailing Address - Country:US
Mailing Address - Phone:336-317-0224
Mailing Address - Fax:
Practice Address - Street 1:315 SHORTER AVE SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4267
Practice Address - Country:US
Practice Address - Phone:706-233-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0027002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer