Provider Demographics
NPI:1699044172
Name:CAST THERAPY LLC
Entity type:Organization
Organization Name:CAST THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-881-4211
Mailing Address - Street 1:4555 LAKE FOREST DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3785
Mailing Address - Country:US
Mailing Address - Phone:513-281-2278
Mailing Address - Fax:513-221-8219
Practice Address - Street 1:4555 LAKE FOREST DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-3785
Practice Address - Country:US
Practice Address - Phone:513-281-2278
Practice Address - Fax:513-221-8219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR ADVANCED SPINE TECHNOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty