Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD00042344 | WA |
NPI | 1033209853 |
---|---|
Provider Name | Kevin T. Caserta |
First Address | Portland, OR 97208-3360 |
Second Address | Centralia, WA 98531-9162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 03/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8141947 | (05) | WA |
H82360 | (02) | WA |