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General NPI Number Information
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NPI Number | 1891039137
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Entity Type | Individual
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Provider Name | CRYSTAL CASTO LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 11200 GOVERNOR MANLY WAY SUITE 209
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City | RALEIGH
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State | NC
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Zip | 27614-8599
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Country | US
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Telephone | 919-562-9410
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 SHORE VIEW RD APT 30
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City | RALEIGH
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State | NC
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Zip | 27613-3991
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2056
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License Number State | NC
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