Provider Demographics
NPI:1942525449
Name:CHARLEBOIS, CASEY (MS,MPT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:CHARLEBOIS
Suffix:
Gender:F
Credentials:MS,MPT
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21316 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1047
Mailing Address - Country:US
Mailing Address - Phone:248-733-4325
Mailing Address - Fax:
Practice Address - Street 1:36800 WOODWARD AVE STE 210
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0917
Practice Address - Country:US
Practice Address - Phone:248-543-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10389225100000X
MI5501019764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist