Provider Demographics
NPI:1346036555
Name:PALACIOS, CASEY JANE (MPT)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:JANE
Last Name:PALACIOS
Suffix:
Gender:
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 EDWARD TER
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1521
Mailing Address - Country:US
Mailing Address - Phone:314-374-3624
Mailing Address - Fax:
Practice Address - Street 1:481 DANA MEADOWS LN
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-6493
Practice Address - Country:US
Practice Address - Phone:314-626-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008025804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist