Provider Demographics
NPI:1376528596
Name:MCCASLIN, RODNEY LANCE (PT)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:LANCE
Last Name:MCCASLIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:720 FAIRGROUND AVE
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1638
Practice Address - Country:US
Practice Address - Phone:660-584-7801
Practice Address - Fax:660-584-8619
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009009835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
42614058OtherBCBS KC
MOMA4370021OtherMEDICARE PTAN
MOR26000004Medicare PIN
MO42614048OtherBCKS OF KC