Provider Demographics
NPI:1598550105
Name:WEGENER, CASEY (PTA)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:WEGENER
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HUMPHREY
Mailing Address - State:NE
Mailing Address - Zip Code:68642-3105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1222 S 7TH ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NE
Practice Address - Zip Code:68620-1716
Practice Address - Country:US
Practice Address - Phone:402-395-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1431225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant