Provider Demographics
NPI:1043736366
Name:CASTORINA - MILLO, TERESA (PTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CASTORINA - MILLO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 REDSTONE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-7607
Mailing Address - Country:US
Mailing Address - Phone:866-474-6677
Mailing Address - Fax:
Practice Address - Street 1:655 E MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4328
Practice Address - Country:US
Practice Address - Phone:281-286-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2111945225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant