Provider Demographics
NPI:1922627512
Name:STAIDL, CASEY J
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:STAIDL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 ACREDALE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5907
Mailing Address - Country:US
Mailing Address - Phone:904-553-1236
Mailing Address - Fax:
Practice Address - Street 1:5300 KEMPSRIVER DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5369
Practice Address - Country:US
Practice Address - Phone:757-233-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer