Provider Demographics
NPI:1013531029
Name:PHETTEPLACE, CASIE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:CASIE
Middle Name:MARIE
Last Name:PHETTEPLACE
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 1:40845 MERCHANTS LN
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3767
Mailing Address - Country:US
Mailing Address - Phone:240-530-8188
Mailing Address - Fax:301-638-0470
Practice Address - Street 1:40845 MERCHANTS LN
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3767
Practice Address - Country:US
Practice Address - Phone:240-530-8188
Practice Address - Fax:301-638-0470
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist