Provider Demographics
NPI:1568653707
Name:PARR, CASEY WAYNE (PT)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:WAYNE
Last Name:PARR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2424 N. WYATT DR. #200
Mailing Address - Street 2:CREDENTIALING DEPT.
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6118
Mailing Address - Country:US
Mailing Address - Phone:520-784-6200
Mailing Address - Fax:520-784-6109
Practice Address - Street 1:6320 N. LA CHOLLA BLVD.
Practice Address - Street 2:#200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-3549
Practice Address - Country:US
Practice Address - Phone:520-382-8200
Practice Address - Fax:520-297-3505
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5363225100000X, 2251P0200X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ788101Medicaid
AZZ135145Medicare PIN