Provider Demographics
NPI:1023686292
Name:DEL CASTILLO, MARCO ANGELO LUNA (PT)
Entity type:Individual
Prefix:MR
First Name:MARCO ANGELO
Middle Name:LUNA
Last Name:DEL 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 1:15 LAKE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3251
Mailing Address - Country:US
Mailing Address - Phone:177-388-6428
Mailing Address - Fax:
Practice Address - Street 1:15 LAKE RIDGE CT
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3251
Practice Address - Country:US
Practice Address - Phone:177-388-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015629261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy