Provider Demographics
NPI:1619429271
Name:CARLSON, CASEY DEAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:DEAN
Last Name:CARLSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3308
Mailing Address - Country:US
Mailing Address - Phone:785-532-7244
Mailing Address - Fax:785-532-1776
Practice Address - Street 1:1800 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3308
Practice Address - Country:US
Practice Address - Phone:785-532-7244
Practice Address - Fax:785-532-1776
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24011422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000010876OtherBOARD OF CERTIFICATION
GAAT002151OtherGEORGIA BOARD OF ATHLETIC TRAINERS
KS2401142OtherKANSAS BOARD OF HEALING ARTS ATHLETIC
COAT.0001391OtherDEPARTMENT OF REGULATORY AGENCIES ATHLETIC TRAINING