Provider Demographics
NPI:1972221976
Name:CASTRO, LARISSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:CASTRO
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 1:8111 N LOOP DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-4159
Mailing Address - Country:US
Mailing Address - Phone:915-593-4985
Mailing Address - Fax:915-593-5187
Practice Address - Street 1:2270 JOE BATTLE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2609
Practice Address - Country:US
Practice Address - Phone:915-855-7780
Practice Address - Fax:915-855-7781
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1366847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist