Provider Demographics
NPI:1770847220
Name:MANNIX, KASEY HARWOOD (DPT)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:HARWOOD
Last Name:MANNIX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N MONTANA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3845
Mailing Address - Country:US
Mailing Address - Phone:406-442-4325
Mailing Address - Fax:406-449-6531
Practice Address - Street 1:900 N MONTANA AVE STE A
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3845
Practice Address - Country:US
Practice Address - Phone:406-442-4325
Practice Address - Fax:406-449-6531
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4351OtherMONTANA STATE LICENSE