Provider Demographics
NPI:1528552817
Name:CASTILLO, EMMA M (RPT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:M
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:EMMA
Other - Middle Name:BELENA
Other - Last Name:MASA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:3021 HELEN LN
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2315
Mailing Address - Country:US
Mailing Address - Phone:626-272-5415
Mailing Address - Fax:
Practice Address - Street 1:3021 HELEN LN
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-2315
Practice Address - Country:US
Practice Address - Phone:626-272-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist