Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 10345-24 | WI |
N | 2251E1200X | Ergonomics | 10345-24 | WI |
N | 225XE1200X | Ergonomics | 10345-24 | WI |
NPI | 1730392762 |
---|---|
Provider Name | Charles Montgomery Castleberg |
First Address | Green Bay, WI 54313 |
Second Address | Green Bay, WI 54301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36123900 | (05) | WI |