1356730998 NPI number — CASEY CASH P.T., D.P.T

Table of content: CASEY CASH P.T., D.P.T (NPI 1356730998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356730998 NPI number — CASEY CASH P.T., D.P.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASH
Provider First Name:
CASEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.P.T
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEIBERT
Provider Other First Name:
CASEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T., D.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356730998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2778 W 22ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80211-5108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-570-3793
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 E 58TH AVE
Provider Second Line Business Practice Location Address:
#111
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80216-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-292-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT-3757 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PTL.0013114 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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