Provider Demographics
NPI:1588985055
Name:KORTH, CASIE L (PT)
Entity type:Individual
Prefix:MRS
First Name:CASIE
Middle Name:L
Last Name:KORTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CASIE
Other - Middle Name:L
Other - Last Name:ROESLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N1245 TECHNICAL DR APT 6
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8739
Mailing Address - Country:US
Mailing Address - Phone:920-585-2650
Mailing Address - Fax:
Practice Address - Street 1:820 E GRANT ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3483
Practice Address - Country:US
Practice Address - Phone:920-831-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11434-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist