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NPI Code Detail

MEDICARE: CASEY EISON PT

MEDICARE: CASEY EISON 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
1225100000XPhysical Therapist7848TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17848OTHERTNLICENSE

General Provider Information

NPI Number : 1881882330
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY EISON PT
Provider Business Mailing Address
First Line : 331 LANDRUM PL
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37043-6329
Country : US
Telephone Number : 931-221-9967
Fax Number :
Provider Business Practice Location Address
First Line : 331 LANDRUM PL
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37043-6329
Country : US
Telephone Number : 931-221-9967
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2007
Last Update Date : 10/10/2007

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