Provider Demographics
NPI:1811474356
Name:CASAMASSINA, KELLIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:
Last Name:CASAMASSINA
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 1:67 FIELDCREST WAY
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1939
Mailing Address - Country:US
Mailing Address - Phone:732-217-3323
Mailing Address - Fax:
Practice Address - Street 1:77 SCHANCK RD # C-3
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2964
Practice Address - Country:US
Practice Address - Phone:732-414-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01791000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist