Provider Demographics
NPI:1376608281
Name:CASTLEMAN, RANDY D (PT)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:D
Last Name:CASTLEMAN
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 1:85081 TUM A LUM RD
Mailing Address - Street 2:
Mailing Address - City:MILTON FREEWATER
Mailing Address - State:OR
Mailing Address - Zip Code:97862-7411
Mailing Address - Country:US
Mailing Address - Phone:509-540-9318
Mailing Address - Fax:
Practice Address - Street 1:56 N COLLEGE AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1048
Practice Address - Country:US
Practice Address - Phone:509-540-9318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4284225100000X
WAPT00007989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0153020OtherDEPT LABOR & INDUSTRIES
OR230022Medicaid
OR230022Medicaid