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NPI Code Detail

MEDICARE: CASEY SHORTT PTA

MEDICARE: CASEY SHORTT PTA
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
1225200000XPhysical Therapy Assistant5502008340MI

General Provider Information

NPI Number : 1417641291
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY SHORTT PTA
Provider Business Mailing Address
First Line : 33900 HARPER AVE STE 104
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-350-2644
Fax Number : 586-541-3735
Provider Business Practice Location Address
First Line : 51635 10 MILE RD
Second Line :
City : SOUTH LYON
State : MI
Zip : 48178-9720
Country : US
Telephone Number : 248-278-1072
Fax Number : 248-278-1073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2023
Last Update Date : 06/06/2023

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Directions to “ CASEY SHORTT PTA” Practice Location

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