Healthcare Provider Details

I. General information

NPI: 1154768596
Provider Name (Legal Business Name): CASEY STOKES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 W ST JOE HWY SUITE 101
LANSING MI
48917
US

IV. Provider business mailing address

4911 W ST JOE HWY STE 101
LANSING MI
48917-4088
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-6800
  • Fax: 517-853-6801
Mailing address:
  • Phone: 517-853-6800
  • Fax: 517-853-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501016297
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: