Healthcare Provider Details

I. General information

NPI: 1487587143
Provider Name (Legal Business Name): CASEY BEAZLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 N 7TH ST APT 261
PHOENIX AZ
85014-3938
US

IV. Provider business mailing address

4949 N 7TH ST APT 261
PHOENIX AZ
85014-3938
US

V. Phone/Fax

Practice location:
  • Phone: 928-205-8130
  • Fax:
Mailing address:
  • Phone: 928-205-8130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberLPT-034315
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: