Provider Demographics
NPI:1811207665
Name:STIEREN, CASEY J (DPT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:STIEREN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:J
Other - Last Name:DEVRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 EASTLAND DR BLDG C
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3534
Mailing Address - Country:US
Mailing Address - Phone:309-662-2278
Mailing Address - Fax:309-663-2956
Practice Address - Street 1:1505 EASTLAND DR BLDG C
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-662-2278
Practice Address - Fax:309-663-2956
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10619225100000X
IL070-018157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-018157OtherIL LICENSE NO
AZ898676Medicaid
AZZ165999Medicare PIN