Provider Demographics
NPI:1497487128
Name:BESSO, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BESSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 N MAIN ST APT 601
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-7058
Mailing Address - Country:US
Mailing Address - Phone:331-401-4701
Mailing Address - Fax:
Practice Address - Street 1:913 N MAIN ST APT 601
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-7058
Practice Address - Country:US
Practice Address - Phone:331-401-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.022588225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist