Provider Demographics
NPI:1609385814
Name:CASTRO, LUIS V (PT)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:V
Last Name:CASTRO
Suffix:
Gender:M
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:PO BOX 2153 DEPT 1947
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-1689
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:
Practice Address - Street 1:110 N JERRY CLOWER BLVD STE M
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-8669
Practice Address - Country:US
Practice Address - Phone:662-763-3750
Practice Address - Fax:662-763-3721
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist