MEDICARE: MR. CRAIG CHRISTOPHER CASTOR ATC,LAT

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
1	2255A2300X	Athletic Trainer	RT001574A	PA

General Provider Information

NPI Number	:	1245902162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG CHRISTOPHER CASTOR ATC,LAT

Provider Business Mailing Address
First Line	:	3001 COOL SPRINGS DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-2033
Country	:	US
Telephone Number	:	412-225-4510
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 COOL SPRINGS DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-2033
Country	:	US
Telephone Number	:	412-225-4510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	09/29/2021

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