Provider Demographics
NPI:1316405749
Name:KASTL, CARLA MARY (PTA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARY
Last Name:KASTL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MARY
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1381 COUNTY ROAD 28
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:NE
Mailing Address - Zip Code:68070-4041
Mailing Address - Country:US
Mailing Address - Phone:402-310-2838
Mailing Address - Fax:
Practice Address - Street 1:1400 MARK DR
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-4023
Practice Address - Country:US
Practice Address - Phone:402-443-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE952225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant