Provider Demographics
NPI:1952093510
Name:CASTANO LASTRE, ENEIDA MARIA (PTA)
Entity Type:Individual
Prefix:
First Name:ENEIDA
Middle Name:MARIA
Last Name:CASTANO LASTRE
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 1:4200 SCOTLAND ST APT 617
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-7496
Mailing Address - Country:US
Mailing Address - Phone:727-225-3643
Mailing Address - Fax:
Practice Address - Street 1:6336 WOODWAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1750
Practice Address - Country:US
Practice Address - Phone:713-423-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2175641225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant