Provider Demographics
NPI:1245969237
Name:EBELT, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:EBELT
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 1:20989 HOLLORON LN
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59834-8515
Mailing Address - Country:US
Mailing Address - Phone:406-461-9879
Mailing Address - Fax:
Practice Address - Street 1:20989 HOLLORON LN
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:MT
Practice Address - Zip Code:59834-8515
Practice Address - Country:US
Practice Address - Phone:406-461-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist