Provider Demographics
NPI:1992031710
Name:CASTILLO, RODOLFO (PT)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-5205
Mailing Address - Country:US
Mailing Address - Phone:817-465-8616
Mailing Address - Fax:
Practice Address - Street 1:311 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5205
Practice Address - Country:US
Practice Address - Phone:817-465-8616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist