Provider Demographics
NPI:1619420080
Name:BACZEWSKI, CASEY (PT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BACZEWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8381
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:VT
Mailing Address - Zip Code:05451-8381
Mailing Address - Country:US
Mailing Address - Phone:802-399-2318
Mailing Address - Fax:802-399-2505
Practice Address - Street 1:520 AVENUE D
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7136
Practice Address - Country:US
Practice Address - Phone:802-399-2318
Practice Address - Fax:802-399-2505
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist