Provider Demographics
NPI:1396727186
Name:CASTLE, PAUL A (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:CASTLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:CASTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:213 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7623
Mailing Address - Country:US
Mailing Address - Phone:606-325-3341
Mailing Address - Fax:
Practice Address - Street 1:2700 GREENUP AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1953
Practice Address - Country:US
Practice Address - Phone:606-324-0540
Practice Address - Fax:606-324-0616
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002418225100000X
OHPT 07896225100000X
WV001579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001639000Medicaid
KY8700025300Medicaid
OH2055171Medicaid
WV0001639001Medicaid
OH2055172Medicaid
OH0845141Medicare PIN
KY5024401Medicare PIN
WV0001639000Medicaid
OH2055172Medicaid
OH2055171Medicaid
KY8700025300Medicaid
WV0001639001Medicaid
WV650018789Medicare PIN