1518333954 NPI number — CARYCE CASEY DPT

Table of content: CARYCE CASEY DPT (NPI 1518333954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518333954 NPI number — CARYCE CASEY DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASEY
Provider First Name:
CARYCE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORELL
Provider Other First Name:
CARYCE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518333954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAREMONT
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03743-4999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-542-1878
Provider Business Mailing Address Fax Number:
603-542-1813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03773-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-542-1878
Provider Business Practice Location Address Fax Number:
603-542-1813
Provider Enumeration Date:
08/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4012 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3108079 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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