Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 18523 | FL |
NPI | 1013288307 |
---|---|
Provider Name | Noel Castro |
First Address | Orlando, FL 32828-4831 |
Second Address | Orlando, FL 32828-4831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2012 |
Last Update Date | 19/01/2012 |