Provider Demographics
NPI:1366101610
Name:KAESTNER, BRIAN HENRY
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:HENRY
Last Name:KAESTNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 ROBINSON AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3244
Mailing Address - Country:US
Mailing Address - Phone:650-930-0741
Mailing Address - Fax:
Practice Address - Street 1:1020 TIERRA DEL REY STE A-1
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7886
Practice Address - Country:US
Practice Address - Phone:619-585-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist