Provider Demographics
NPI:1659511368
Name:CASTELLON, SHAWN REY (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:REY
Last Name:CASTELLON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SHAWN
Other - Middle Name:REY
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 DIAMOND DR STE 101
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4495
Practice Address - Country:US
Practice Address - Phone:951-674-9515
Practice Address - Fax:951-674-9517
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17068225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist