Provider Demographics
NPI:1215916630
Name:KASTLER, MICHELLE RAE (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RAE
Last Name:KASTLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RAE
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 FALCON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311-1005
Mailing Address - Country:US
Mailing Address - Phone:940-676-3873
Mailing Address - Fax:940-676-3335
Practice Address - Street 1:149 HART ST
Practice Address - Street 2:82 MEDICAL GROUP
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-3477
Practice Address - Country:US
Practice Address - Phone:940-676-3873
Practice Address - Fax:940-676-3335
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN