Provider Demographics
NPI:1336726504
Name:MOLES, CASEY R
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:R
Last Name:MOLES
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 1:515 S EAST END RD
Mailing Address - Street 2:
Mailing Address - City:STRAW PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37871-4425
Mailing Address - Country:US
Mailing Address - Phone:865-221-4136
Mailing Address - Fax:
Practice Address - Street 1:220 LONGMIRE RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-7338
Practice Address - Country:US
Practice Address - Phone:865-457-6925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6350225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant