Provider Demographics
NPI:1164061412
Name:CASTRELL NEUROMUSCULAR THERAPY
Entity Type:Organization
Organization Name:CASTRELL NEUROMUSCULAR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CROFT
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CMT, BCTMB
Authorized Official - Phone:408-899-4085
Mailing Address - Street 1:4155 MOORPARK AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1714
Mailing Address - Country:US
Mailing Address - Phone:408-899-4085
Mailing Address - Fax:408-498-9746
Practice Address - Street 1:4155 MOORPARK AVE STE 20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1714
Practice Address - Country:US
Practice Address - Phone:408-899-4085
Practice Address - Fax:408-498-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-04
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty