Provider Demographics
NPI:1023061470
Name:GASTLER, HEIDI L (DPT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:GASTLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3888
Mailing Address - Country:US
Mailing Address - Phone:310-567-2293
Mailing Address - Fax:310-919-0447
Practice Address - Street 1:3212 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3888
Practice Address - Country:US
Practice Address - Phone:310-567-2293
Practice Address - Fax:310-919-0447
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN196P6GAOtherBLUE CROSS BLUE SHIELD
MN713523800Medicaid
MN6405758OtherMEDICA
MNP00278533OtherRAILROAD MEDICARE
MN125107OtherUCARE
MN936131043346OtherPREFERRED ONE
MNHP53380OtherHEALTH PARTNERS
MN650001337Medicare ID - Type Unspecified