Provider Demographics
NPI:1578111381
Name:CASINO, JEREMIAH NATHAN (DPT)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:NATHAN
Last Name:CASINO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23655 VIA DEL RIO STE C
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-2718
Mailing Address - Country:US
Mailing Address - Phone:714-695-1566
Mailing Address - Fax:714-695-1553
Practice Address - Street 1:23655 VIA DEL RIO STE C
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887
Practice Address - Country:US
Practice Address - Phone:714-695-1566
Practice Address - Fax:714-695-1553
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2972822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic