Provider Demographics
NPI:1225032600
Name:MCKASKLE, MICHAEL BART (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BART
Last Name:MCKASKLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1519
Mailing Address - Country:US
Mailing Address - Phone:806-771-8008
Mailing Address - Fax:806-771-8009
Practice Address - Street 1:2431 S LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1519
Practice Address - Country:US
Practice Address - Phone:806-771-8008
Practice Address - Fax:806-771-8009
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1133445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219904402Medicaid
TX8T1365OtherBLUE CROSS BLUE SHIELD
TX219904401Medicaid
TX141193101OtherFIRSTCARE
TXP00169854OtherMEDICARE RAILROAD
TX219904402Medicaid