Basic Information
| Provider Information | |||||||||
| NPI: | 1679913644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | CASIE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HILTON | ||||||||
| OtherFirstName: | CASIE | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2416 HIGHWAY 45 N | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397051320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623276705 | ||||||||
| FaxNumber: | 6623276760 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 N WALMART DR | ||||||||
| Address2: | SUITE F | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393395905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627791096 | ||||||||
| FaxNumber: | 6627793949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2013 | ||||||||
| LastUpdateDate: | 01/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT5316 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.