Provider Demographics
NPI:1700277068
Name:CASEY, JESSICA (PTA, ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GUREKOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA, ATC
Mailing Address - Street 1:10812 SE 229TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2605
Mailing Address - Country:US
Mailing Address - Phone:206-412-2528
Mailing Address - Fax:
Practice Address - Street 1:1201 TERRY AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2735
Practice Address - Country:US
Practice Address - Phone:206-223-7528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1600702072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer