Provider Demographics
NPI:1376059774
Name:DUVAL, CASEY JEAN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:JEAN
Last Name:DUVAL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1122
Mailing Address - Country:US
Mailing Address - Phone:312-479-8689
Mailing Address - Fax:
Practice Address - Street 1:2601 BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9780
Practice Address - Country:US
Practice Address - Phone:847-532-6153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960039942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer