Provider Demographics
NPI:1639140064
Name:DOYLE, CASEY (PT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:DOYLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 W BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3145
Mailing Address - Country:US
Mailing Address - Phone:319-352-0102
Mailing Address - Fax:319-352-0104
Practice Address - Street 1:413 W BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3145
Practice Address - Country:US
Practice Address - Phone:319-352-0102
Practice Address - Fax:319-352-0104
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0289942Medicaid
IA18718OtherBC/BS
IA0289942Medicaid