Provider Demographics
NPI:1639917404
Name:CASTILLO, KAROL (OWNER)
Entity type:Individual
Prefix:
First Name:KAROL
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 HULL AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1641
Mailing Address - Country:US
Mailing Address - Phone:929-671-9649
Mailing Address - Fax:
Practice Address - Street 1:3013 STEINWAY ST STE 2F
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3456
Practice Address - Country:US
Practice Address - Phone:929-671-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist