Provider Demographics
NPI:1982048765
Name:KASTLER, BEN JAY (ATC)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:JAY
Last Name:KASTLER
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 1:293 BENT GRASS CIR
Mailing Address - Street 2:UNIT A
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-8685
Mailing Address - Country:US
Mailing Address - Phone:815-761-2323
Mailing Address - Fax:
Practice Address - Street 1:293 BENT GRASS CIR
Practice Address - Street 2:UNIT A
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-8685
Practice Address - Country:US
Practice Address - Phone:815-761-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960028042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer