Provider Demographics
NPI:1881021228
Name:CASTRO, ANTHONY R (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:CASTRO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 SUMMER GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-5234
Mailing Address - Country:US
Mailing Address - Phone:478-538-1436
Mailing Address - Fax:478-474-6601
Practice Address - Street 1:164 SUMMER GROVE LN
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-5234
Practice Address - Country:US
Practice Address - Phone:478-538-1436
Practice Address - Fax:478-474-6601
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist