Healthcare Provider Details

I. General information

NPI: 1508084401
Provider Name (Legal Business Name): HEATHER KNAUER KASTANARAS MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8965 GUILFORD RD SUITE 160
COLUMBIA MD
21046-2384
US

IV. Provider business mailing address

3322 WOODSIDE AVE
BALTIMORE MD
21234-4843
US

V. Phone/Fax

Practice location:
  • Phone: 410-796-8499
  • Fax: 443-270-8260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number19017
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: