MEDICARE: KATHLEEN CASE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT528	ME

General Provider Information

NPI Number	:	1306393426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN CASE PT

Provider Business Mailing Address
First Line	:	162 ACADEMY ST
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-3180
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	162 ACADEMY ST
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-3180
Country	:	US
Telephone Number	:	207-764-0145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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Directions to “ KATHLEEN CASE PT” Practice Location

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