Provider Demographics
NPI:1114204708
Name:CASTILLO, CHRISTINE (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 143RD PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-6429
Mailing Address - Country:US
Mailing Address - Phone:206-779-8239
Mailing Address - Fax:
Practice Address - Street 1:703 143RD PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-6429
Practice Address - Country:US
Practice Address - Phone:206-779-8239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60255479225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist