Healthcare Provider Details

I. General information

NPI: 1801586169
Provider Name (Legal Business Name): ANDREW JOSEPH CASTELEIN PT, DPT, AT/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 W BRENDA LOOP
FLAGSTAFF AZ
86001-0916
US

IV. Provider business mailing address

3080 W BRENDA LOOP
FLAGSTAFF AZ
86001-0916
US

V. Phone/Fax

Practice location:
  • Phone: 480-459-8451
  • Fax:
Mailing address:
  • Phone: 480-459-8451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-008926
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR-000531
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: