Provider Demographics
NPI:1235457011
Name:CASTRO, RAFAEL ALFRED RIVERA (PTRP,RPT)
Entity Type:Individual
Prefix:
First Name:RAFAEL ALFRED
Middle Name:RIVERA
Last Name:CASTRO
Suffix:
Gender:M
Credentials:PTRP,RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ASHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4317
Mailing Address - Country:US
Mailing Address - Phone:646-209-9109
Mailing Address - Fax:
Practice Address - Street 1:14 ASHBROOK DR.
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:646-209-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist