Provider Demographics
NPI:1447798228
Name:LEMAY, CASEY WILLIAM (PTA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:WILLIAM
Last Name:LEMAY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 CENTENNIAL CENTRE BLVD
Mailing Address - Street 2:APT 54
Mailing Address - City:HOBART
Mailing Address - State:WI
Mailing Address - Zip Code:54155-8678
Mailing Address - Country:US
Mailing Address - Phone:920-255-4137
Mailing Address - Fax:
Practice Address - Street 1:1635 S 21ST ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6380
Practice Address - Country:US
Practice Address - Phone:262-923-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2517-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant