Provider Demographics
NPI:1437715976
Name:SAMPLES, CASEY M (PTA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:M
Last Name:SAMPLES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:M
Other - Last Name:DEVOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:906 N 15TH TER
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:MO
Mailing Address - Zip Code:64485-1173
Mailing Address - Country:US
Mailing Address - Phone:402-310-9549
Mailing Address - Fax:
Practice Address - Street 1:904 S HALL AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:MO
Practice Address - Zip Code:64485-1952
Practice Address - Country:US
Practice Address - Phone:816-324-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016030514225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant