Provider Demographics
NPI:1871972034
Name:POWLES, CASEY (DPT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:POWLES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3073
Mailing Address - Country:US
Mailing Address - Phone:757-481-4066
Mailing Address - Fax:757-481-3779
Practice Address - Street 1:6330 NEWTOWN RD STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4803
Practice Address - Country:US
Practice Address - Phone:757-466-4401
Practice Address - Fax:757-466-4404
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist