Provider Demographics
NPI:1932579844
Name:CASTON, DEANNA MICHELLE
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:MICHELLE
Last Name:CASTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22250 PROVIDENCE DR STE 405
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6212
Practice Address - Country:US
Practice Address - Phone:248-996-1770
Practice Address - Fax:248-996-1773
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2025-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2602664174400000X
MI5502008763225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No174400000XOther Service ProvidersSpecialist