Provider Demographics
NPI:1477979110
Name:BRAENDLE, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BRAENDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 COLES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2632
Mailing Address - Country:US
Mailing Address - Phone:740-354-5671
Mailing Address - Fax:740-354-4432
Practice Address - Street 1:1656 COLES BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2632
Practice Address - Country:US
Practice Address - Phone:740-354-5671
Practice Address - Fax:740-354-4432
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT015380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist