Healthcare Provider Details

I. General information

NPI: 1699044172
Provider Name (Legal Business Name): CAST THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 LAKE FOREST DR SUITE 150
BLUE ASH OH
45242-3785
US

IV. Provider business mailing address

4555 LAKE FOREST DR SUITE 150
BLUE ASH OH
45242-3785
US

V. Phone/Fax

Practice location:
  • Phone: 513-281-2278
  • Fax: 513-221-8219
Mailing address:
  • Phone: 513-281-2278
  • Fax: 513-221-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateOH

VIII. Authorized Official

Name: JACK JOHNSON
Title or Position: CFO
Credential:
Phone: 281-881-4211