Provider Demographics
NPI:1629203021
Name:CASTRO, JEAN PAUL GRIMES (PT)
Entity Type:Individual
Prefix:
First Name:JEAN PAUL
Middle Name:GRIMES
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 1:4 GREENWICH DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1151
Mailing Address - Country:US
Mailing Address - Phone:732-428-5566
Mailing Address - Fax:732-428-5513
Practice Address - Street 1:1600 SAINT GEORGES AVE
Practice Address - Street 2:107
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2764
Practice Address - Country:US
Practice Address - Phone:732-428-5566
Practice Address - Fax:732-428-5513
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00600100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist