Provider Demographics
NPI:1851584569
Name:CASEY, REBECCA ANNE (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:CASEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 1/2 GREEN ST
Mailing Address - Street 2:APT. C
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1963
Mailing Address - Country:US
Mailing Address - Phone:402-740-3119
Mailing Address - Fax:
Practice Address - Street 1:101 1/2 GREEN ST
Practice Address - Street 2:APT. C
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1963
Practice Address - Country:US
Practice Address - Phone:402-740-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-26
Last Update Date:2007-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist