Provider Demographics
NPI:1508753062
Name:HUMPHREYS, CASEY J (CSW, LMT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:CSW, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4178 S KIERA HILL LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2743
Mailing Address - Country:US
Mailing Address - Phone:385-377-4411
Mailing Address - Fax:
Practice Address - Street 1:4178 S KIERA HILL LN
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2743
Practice Address - Country:US
Practice Address - Phone:385-377-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7734967-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist