Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2305204145 | VA |
NPI | 1013413699 |
---|---|
Provider Name | Mrs. Melissa Anne Casey |
First Address | Berryville, VA 22611-1513 |
Second Address | Berryville, VA 22611-1513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2018 |
Last Update Date | 03/04/2018 |