Provider Demographics
NPI:1497460778
Name:CRUZ CASTILLO, JEFFREY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:CRUZ CASTILLO
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:CRUZ
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:720 GEORGE HEGE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-9023
Mailing Address - Country:US
Mailing Address - Phone:336-470-8874
Mailing Address - Fax:
Practice Address - Street 1:720 GEORGE HEGE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-9023
Practice Address - Country:US
Practice Address - Phone:336-470-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty