Healthcare Provider Details

I. General information

NPI: 1730392762
Provider Name (Legal Business Name): CHARLES MONTGOMERY CASTLEBERG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 S OVERLAND RD
ONEIDA WI
54155-8959
US

IV. Provider business mailing address

PO BOX 365
ONEIDA WI
54155-0365
US

V. Phone/Fax

Practice location:
  • Phone: 920-869-2711
  • Fax:
Mailing address:
  • Phone: 920-869-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10345-24
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number10345-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: