Provider Demographics
NPI:1457529547
Name:CASTILLO, CLAUDIA FERNANDA (PTA)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:FERNANDA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15530 SW 115TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6313
Mailing Address - Country:US
Mailing Address - Phone:786-246-7381
Mailing Address - Fax:
Practice Address - Street 1:10739 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1421
Practice Address - Country:US
Practice Address - Phone:305-222-1892
Practice Address - Fax:305-222-1896
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21163225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant