Individual
KEVIN T. CASERTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 COOKS HILL RD STE E, CENTRALIA, WA 98531-9162
(360) 330-8626
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(360) 330-8626
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD00042344
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8141947
—
WA
Enumeration date
10/13/2006
Last updated
05/03/2021
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