Provider Demographics
NPI:1437565462
Name:CASEY, ANN MARIE (PT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:CASEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:245 CHERRY ST SE STE 102
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4607
Practice Address - Country:US
Practice Address - Phone:616-201-3909
Practice Address - Fax:866-563-0637
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60449782225100000X
MI5501303462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60449782OtherPT LICENSE