Provider Demographics
NPI:1700524790
Name:TULCAN, CASEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:TULCAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 FALLS AVE E STE 401
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-813-9544
Mailing Address - Fax:208-810-4499
Practice Address - Street 1:7711 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6254
Practice Address - Country:US
Practice Address - Phone:208-813-9544
Practice Address - Fax:208-810-4499
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302067225100000X
ID3761378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist