Provider Demographics
NPI:1649583592
Name:CASTRO, LILLIAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:LMT
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 430255
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-0255
Mailing Address - Country:US
Mailing Address - Phone:305-519-3824
Mailing Address - Fax:
Practice Address - Street 1:7550 SW 57TH AVE
Practice Address - Street 2:116
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5343
Practice Address - Country:US
Practice Address - Phone:305-519-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA24913225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist