Provider Demographics
NPI:1275107195
Name:BERSTLER, KAYTEE LYNN
Entity Type:Individual
Prefix:
First Name:KAYTEE
Middle Name:LYNN
Last Name:BERSTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PAPILLON RD
Mailing Address - Street 2:UNIT 20
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757
Mailing Address - Country:US
Mailing Address - Phone:319-899-6191
Mailing Address - Fax:
Practice Address - Street 1:3201 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6901
Practice Address - Country:US
Practice Address - Phone:903-723-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
TXAT7952207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2000035187OtherATHLETIC TRAINING BOARD OF CERTIFICATION
TXAT7952OtherTEXAS DEPARTMENT OF LICENSURE