Provider Demographics
NPI:1063186385
Name:MCCASKILL, KEVIN (PTA, CLT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MCCASKILL
Suffix:
Gender:M
Credentials:PTA, CLT
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:MCCASKILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA, CLT
Mailing Address - Street 1:PO BOX 5944
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32314-5944
Mailing Address - Country:US
Mailing Address - Phone:850-241-2311
Mailing Address - Fax:
Practice Address - Street 1:2743 CAPITAL CIR NE STE 106
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-1115
Practice Address - Country:US
Practice Address - Phone:850-725-5008
Practice Address - Fax:850-383-0099
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA29258225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant