Healthcare Provider Details

I. General information

NPI: 1164425088
Provider Name (Legal Business Name): CASEY B MCGHEE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY B MALONE PT

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 CLARINGTON CV
SOUTHAVEN MS
38671-5657
US

IV. Provider business mailing address

6077 PRIMACY PKWY STE 140
MEMPHIS TN
38119-5742
US

V. Phone/Fax

Practice location:
  • Phone: 901-641-3000
  • Fax: 901-259-1698
Mailing address:
  • Phone: 901-725-8347
  • Fax: 901-259-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6882
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: