Provider Demographics
NPI:1932484557
Name:CASTRILLO, LIBAH GONZALEZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:LIBAH
Middle Name:GONZALEZ
Last Name:CASTRILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LIBAH
Other - Middle Name:G
Other - Last Name:CASTRILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3577 JERICHO DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6210
Mailing Address - Country:US
Mailing Address - Phone:407-949-9495
Mailing Address - Fax:
Practice Address - Street 1:3577 JERICHO DR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6210
Practice Address - Country:US
Practice Address - Phone:407-949-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist