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NPI Code Detail

MEDICARE: MICHAEL EVAN KASTAN PT

MEDICARE: MICHAEL EVAN KASTAN PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist305135CA

General Provider Information

NPI Number : 1205602612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL EVAN KASTAN PT
Provider Business Mailing Address
First Line : 3001 PALM VISTA CT
Second Line :
City : EL CAJON
State : CA
Zip : 92019-4644
Country : US
Telephone Number : 619-410-3772
Fax Number :
Provider Business Practice Location Address
First Line : 2690 VIA DE LA VALLE STE D160
Second Line :
City : DEL MAR
State : CA
Zip : 92014-1991
Country : US
Telephone Number : 858-290-0855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2023
Last Update Date : 11/27/2023

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