Provider Demographics
NPI:1447410899
Name:CASTILLO, MIGUEL LUIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:LUIS
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SAINT MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7600
Mailing Address - Country:US
Mailing Address - Phone:505-438-9402
Mailing Address - Fax:505-471-9240
Practice Address - Street 1:720 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7600
Practice Address - Country:US
Practice Address - Phone:505-438-9402
Practice Address - Fax:505-471-9240
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist