Individual
JARED KENNETH CASAZZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
872 PRICES FORK RD, BLACKSBURG, VA 24060-3229
(407) 392-1615
Mailing address
4140 FERNCREEK DR, SUITE 801, FAYETTEVILLE, NC 28314-2563
(910) 484-2171
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305209489
VA
225100000X
Physical Therapist
P16639
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305209489
PHYSICAL THERAPY LICENSE
VA
Enumeration date
09/21/2016
Last updated
03/26/2024
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