Provider Demographics
NPI:1639511835
Name:CASA CARE PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:CASA CARE PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRILLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MAPT, DPT
Authorized Official - Phone:704-892-8074
Mailing Address - Street 1:17115 KENTON DR
Mailing Address - Street 2:SUITE 204-A
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5645
Mailing Address - Country:US
Mailing Address - Phone:704-892-8074
Mailing Address - Fax:704-892-8075
Practice Address - Street 1:17115 KENTON DR
Practice Address - Street 2:SUITE 204-A
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5645
Practice Address - Country:US
Practice Address - Phone:704-892-8074
Practice Address - Fax:704-892-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP114952251P0200X
NC8676225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty