Provider Demographics
NPI:1043534241
Name:CASEY, CELISA ANN (LMT)
Entity type:Individual
Prefix:MS
First Name:CELISA
Middle Name:ANN
Last Name:CASEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 COUNTY ROAD 495
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3749
Mailing Address - Country:US
Mailing Address - Phone:256-601-6743
Mailing Address - Fax:
Practice Address - Street 1:553 MAIN ST W
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-5944
Practice Address - Country:US
Practice Address - Phone:256-638-2295
Practice Address - Fax:256-638-2434
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist