Provider Demographics
NPI:1952179145
Name:CASEY, LEVI ALAN
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:ALAN
Last Name:CASEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:BURNETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47926-8040
Mailing Address - Country:US
Mailing Address - Phone:765-430-7706
Mailing Address - Fax:
Practice Address - Street 1:1700 LINDBERG RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-7317
Practice Address - Country:US
Practice Address - Phone:765-464-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06006637A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant