Healthcare Provider Details

I. General information

NPI: 1881425940
Provider Name (Legal Business Name): CASEY LYNN DAVID PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5695 KYLE PKWY STE 140
KYLE TX
78640-6305
US

IV. Provider business mailing address

4610 SEA SALT DR
AUSTIN TX
78747-4503
US

V. Phone/Fax

Practice location:
  • Phone: 512-268-0140
  • Fax:
Mailing address:
  • Phone: 915-920-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1395281
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: