Provider Demographics
NPI:1376435925
Name:CHILDS, CASEY (LMT, MLD-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:CHILDS
Suffix:
Gender:F
Credentials:LMT, MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 REMOUNT RD STE 306B
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6197
Mailing Address - Country:US
Mailing Address - Phone:828-606-2917
Mailing Address - Fax:
Practice Address - Street 1:2456 REMOUNT RD STE 306B
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6197
Practice Address - Country:US
Practice Address - Phone:828-606-2917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10912225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist