Provider Demographics
NPI:1710584586
Name:GONZALES CASTILLO, GABRIELA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:GONZALES CASTILLO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TROTTER RD APT 431
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-3823
Mailing Address - Country:US
Mailing Address - Phone:617-842-4785
Mailing Address - Fax:
Practice Address - Street 1:200 TROTTER RD APT 431
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-3823
Practice Address - Country:US
Practice Address - Phone:617-842-4785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist