Provider Demographics
NPI:1194073221
Name:FOREST, KASEY (DPT)
Entity type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:
Last Name:FOREST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10390 COLOMA RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2152
Mailing Address - Country:US
Mailing Address - Phone:916-858-0950
Mailing Address - Fax:916-858-0972
Practice Address - Street 1:10390 COLOMA RD
Practice Address - Street 2:SUITE 7
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2152
Practice Address - Country:US
Practice Address - Phone:916-858-0950
Practice Address - Fax:916-858-0972
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist