Provider Demographics
NPI:1467342444
Name:MCCONIHE, CASEY THOMAS
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:THOMAS
Last Name:MCCONIHE
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 1:521 SHADYLAWN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1538
Mailing Address - Country:US
Mailing Address - Phone:440-258-0609
Mailing Address - Fax:
Practice Address - Street 1:400 W STATE ST STE 2
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2530
Practice Address - Country:US
Practice Address - Phone:419-332-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist