Provider Demographics
NPI:1821350273
Name:CASTRO, NANCY G (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:G
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4435
Mailing Address - Country:US
Mailing Address - Phone:815-758-8151
Mailing Address - Fax:
Practice Address - Street 1:1212 S 2ND ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4435
Practice Address - Country:US
Practice Address - Phone:815-758-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2023-06-02
Deactivation Date:2018-05-02
Deactivation Code:
Reactivation Date:2023-06-01
Provider Licenses
StateLicense IDTaxonomies
IL070010144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist