Provider Demographics
NPI:1912136714
Name:CASTILLO, SHARON OMAGTANG (PT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:OMAGTANG
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 63RD DR
Mailing Address - Street 2:APT 5E
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3857
Mailing Address - Country:US
Mailing Address - Phone:347-322-3087
Mailing Address - Fax:
Practice Address - Street 1:8910 63RD DR
Practice Address - Street 2:APT 5E
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3857
Practice Address - Country:US
Practice Address - Phone:347-322-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist