Provider Demographics
NPI:1518673581
Name:HUMMER, KASEY (PTA, CLT, CCI, OPTA)
Entity Type:Individual
Prefix:MISS
First Name:KASEY
Middle Name:
Last Name:HUMMER
Suffix:
Gender:F
Credentials:PTA, CLT, CCI, OPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30867 SCOTT LAND RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-2852
Mailing Address - Country:US
Mailing Address - Phone:302-542-8916
Mailing Address - Fax:
Practice Address - Street 1:20930 DUPONT BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1723
Practice Address - Country:US
Practice Address - Phone:302-856-7462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0001016225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty