Basic Information
| Provider Information | |||||||||
| NPI: | 1457529547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTILLO | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | FERNANDA | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15530 SW 115TH TER | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331966313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862467381 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10739 W FLAGLER ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331741421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052221892 | ||||||||
| FaxNumber: | 3052221896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2008 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA21163 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.