Provider Demographics
NPI:1568011534
Name:MOLER, CASEY B (PT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:B
Last Name:MOLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LYNN
Other - Last Name:BURRUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 RAY C HUNT DR BLDG 515
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2981
Practice Address - Country:US
Practice Address - Phone:434-244-2015
Practice Address - Fax:434-243-0320
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist