Provider Demographics
NPI:1467813949
Name:CASUPANG, RHEA ANN (PT)
Entity Type:Individual
Prefix:
First Name:RHEA
Middle Name:ANN
Last Name:CASUPANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RHEA
Other - Middle Name:ANN
Other - Last Name:DEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 S EASTERN AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0826
Practice Address - Country:US
Practice Address - Phone:702-734-2732
Practice Address - Fax:702-737-1453
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist