Provider Demographics
NPI:1891568978
Name:ANTHONY, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:ANTHONY
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 1:2189 SILAS DEANE HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2324
Mailing Address - Country:US
Mailing Address - Phone:860-900-0174
Mailing Address - Fax:833-220-0104
Practice Address - Street 1:2189 SILAS DEANE HWY STE 7
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2324
Practice Address - Country:US
Practice Address - Phone:860-900-0174
Practice Address - Fax:833-220-0104
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.013680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist