Provider Demographics
NPI:1477804003
Name:CASTILLO, MILDRED TATIANA (PT)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:TATIANA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4971 LE CHALET BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1418
Mailing Address - Country:US
Mailing Address - Phone:561-733-5590
Mailing Address - Fax:561-740-0714
Practice Address - Street 1:4971 LE CHALET BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1418
Practice Address - Country:US
Practice Address - Phone:561-733-5590
Practice Address - Fax:561-740-0714
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-22
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist