Provider Demographics
NPI:1720533649
Name:STIVERS, CASIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CASIE
Middle Name:
Last Name:STIVERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-7697
Mailing Address - Country:US
Mailing Address - Phone:270-526-2094
Mailing Address - Fax:270-526-2095
Practice Address - Street 1:1116 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-9832
Practice Address - Country:US
Practice Address - Phone:270-526-2094
Practice Address - Fax:270-526-2095
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist