MEDICARE: MR. DOUGLAS JAMES CASA PHD, ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1306830914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS JAMES CASA PHD, ATC

Provider Business Mailing Address
First Line	:	75 MAPLE RD
Second Line	:
City	:	STORRS
State	:	CT
Zip	:	06268-2568
Country	:	US
Telephone Number	:	860-429-7720
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 MAPLE RD
Second Line	:
City	:	STORRS
State	:	CT
Zip	:	06268-2568
Country	:	US
Telephone Number	:	860-429-7720
Fax Number	:

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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