Provider Demographics
NPI:1508113820
Name:CASEY, JOSHUA ABE (LMT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ABE
Last Name:CASEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11155 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2024
Mailing Address - Country:US
Mailing Address - Phone:503-894-9005
Mailing Address - Fax:503-719-4178
Practice Address - Street 1:11155 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2024
Practice Address - Country:US
Practice Address - Phone:503-894-9005
Practice Address - Fax:503-719-4178
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist