Provider Demographics
NPI:1790068518
Name:CASTRO, SARAH JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:CASTRO
Other - Last Name:TAGARAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:171 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4636
Mailing Address - Country:US
Mailing Address - Phone:630-540-2819
Mailing Address - Fax:630-540-2819
Practice Address - Street 1:171 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4636
Practice Address - Country:US
Practice Address - Phone:630-540-2819
Practice Address - Fax:630-540-2819
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist