Provider Demographics
NPI:1962264036
Name:CASEY, KELLY ANN (PT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:CASEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:CAPRETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3623 CROSSINGS DR STE 282
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7101
Mailing Address - Country:US
Mailing Address - Phone:928-237-2838
Mailing Address - Fax:928-441-8421
Practice Address - Street 1:3623 CROSSINGS DR STE 282
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7101
Practice Address - Country:US
Practice Address - Phone:855-394-2531
Practice Address - Fax:928-441-8421
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCP027487T225100000X
OH9991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist