MEDICARE: ZACHARY CASTOR PT, DPT

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
1	225100000X	Physical Therapist	9409	SC

General Provider Information

NPI Number	:	1750859880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY CASTOR PT, DPT

Provider Business Mailing Address
First Line	:	2840 CHOPPEE RD
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-7270
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	267 WILLBROOK BLVD UNIT D
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-8618
Country	:	US
Telephone Number	:	843-314-3980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2018
Last Update Date	:	11/07/2018

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