Provider Demographics
NPI:1760796627
Name:CASEY, MAURA (MAURA CASEY)
Entity Type:Individual
Prefix:MS
First Name:MAURA
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:MAURA CASEY
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAURA CASEY
Mailing Address - Street 1:375 S END AVE APT 10N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 S END AVE APT 10N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1021
Practice Address - Country:US
Practice Address - Phone:917-282-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006870-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist