Provider Demographics
NPI:1265604177
Name:CASEY, DIANE (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
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 1:1803 MARSHALL CROSS
Mailing Address - Street 2:APARTMENT 825
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-3704
Mailing Address - Country:US
Mailing Address - Phone:210-260-8346
Mailing Address - Fax:
Practice Address - Street 1:12952 BANDERA RD
Practice Address - Street 2:#107
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4689
Practice Address - Country:US
Practice Address - Phone:210-372-9600
Practice Address - Fax:210-392-9923
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166870225100000X
OH13737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist