Provider Demographics
NPI:1477084374
Name:CASTO, LIAM CHAYSE (ATC)
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:CHAYSE
Last Name:CASTO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-8021
Mailing Address - Country:US
Mailing Address - Phone:740-645-8274
Mailing Address - Fax:
Practice Address - Street 1:101 SERVICE RD
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-8021
Practice Address - Country:US
Practice Address - Phone:740-645-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0058752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer