Provider Demographics
NPI:1285398719
Name:KASTOR, OLIVIA MARIE (DPT, PT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:KASTOR
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2504
Mailing Address - Country:US
Mailing Address - Phone:423-297-1813
Mailing Address - Fax:
Practice Address - Street 1:420 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2504
Practice Address - Country:US
Practice Address - Phone:423-297-1813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37458225100000X
TN16507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist