Provider Demographics
NPI:1992907141
Name:CASEY, DIANE JEANETTE (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:JEANETTE
Last Name:CASEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 W 61ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204
Mailing Address - Country:US
Mailing Address - Phone:316-755-0180
Mailing Address - Fax:316-755-0180
Practice Address - Street 1:2812 W 61 ST N
Practice Address - Street 2:REHAB & CONSULTING PA
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67204
Practice Address - Country:US
Practice Address - Phone:316-993-0188
Practice Address - Fax:316-755-0180
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4887316701Medicaid
KS10751OtherPPK
KS140214OtherBCBS
KS4887316701Medicaid