Provider Demographics
NPI:1720041478
Name:CASTLE, MARK K (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:K
Last Name:CASTLE
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:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:LOWMANSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41232-0191
Mailing Address - Country:US
Mailing Address - Phone:606-668-9481
Mailing Address - Fax:
Practice Address - Street 1:49 KY 15 N
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-8834
Practice Address - Country:US
Practice Address - Phone:606-668-9481
Practice Address - Fax:606-668-7730
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3844OtherMEDICARE GROUP