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NPI Code Detail

MEDICARE: OLIVIA MARIE KASTOR DPT, PT

MEDICARE: OLIVIA MARIE KASTOR DPT, PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist37458FL
2225100000XPhysical Therapist16507TN
3225100000XPhysical Therapist1407671TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285398719
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA MARIE KASTOR DPT, PT
Provider Business Mailing Address
First Line : 5407 NEW COPELAND RD STE 100
Second Line :
City : TYLER
State : TX
Zip : 75703-3997
Country : US
Telephone Number : 903-630-7204
Fax Number :
Provider Business Practice Location Address
First Line : 5407 NEW COPELAND RD STE 100
Second Line :
City : TYLER
State : TX
Zip : 75703-3997
Country : US
Telephone Number : 903-630-7204
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2021
Last Update Date : 01/18/2026

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