Provider Demographics
NPI:1851839211
Name:CASTRO-LARSEN, RICHIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RICHIA
Middle Name:
Last Name:CASTRO-LARSEN
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 1:24892 STATE HIGHWAY 89
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-9626
Mailing Address - Country:US
Mailing Address - Phone:530-336-5511
Mailing Address - Fax:
Practice Address - Street 1:43563 STATE HIGHWAY 299 E
Practice Address - Street 2:
Practice Address - City:FALL RIVER MILLS
Practice Address - State:CA
Practice Address - Zip Code:96028-9787
Practice Address - Country:US
Practice Address - Phone:530-336-5511
Practice Address - Fax:530-336-5722
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist