Provider Demographics
NPI:1902355621
Name:CASNER, ANDREW JAMES
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JAMES
Last Name:CASNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1716
Mailing Address - Country:US
Mailing Address - Phone:217-562-6328
Mailing Address - Fax:217-562-6281
Practice Address - Street 1:101 E 9TH ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1716
Practice Address - Country:US
Practice Address - Phone:217-562-6328
Practice Address - Fax:217-562-6281
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0027692255A2300X
IL160.008482225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer