Provider Demographics
NPI:1598377400
Name:CASEY, KATHLENE
Entity type:Individual
Prefix:
First Name:KATHLENE
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 PROSPERITY FARMS RD STE B104
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3453
Mailing Address - Country:US
Mailing Address - Phone:561-537-4526
Mailing Address - Fax:
Practice Address - Street 1:106 PONCE DE LEON ST
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1213
Practice Address - Country:US
Practice Address - Phone:561-791-9090
Practice Address - Fax:561-791-9071
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT36221OtherDEPARTMENT OF HEALTH