Basic Information
| Provider Information | |||||||||
| NPI: | 1053587139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVINE | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 3650 CAPE CENTER DR | ||||||||
| Address2: | SUITE201 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283042139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104235550 | ||||||||
| FaxNumber: | 9104235552 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 CAPE CENTER DR | ||||||||
| Address2: | SUITE201 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283042139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104235550 | ||||||||
| FaxNumber: | 9104235552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2008 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 992 | NC | Y | Other Service Providers | Specialist |
No ID Information.