MEDICARE: KAYLA CASTRO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	044166	NY

General Provider Information

NPI Number	:	1023576048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA CASTRO

Provider Business Mailing Address
First Line	:	900 ROUTE 9 N STE 410
Second Line	:
City	:	WOODBRIDGE
State	:	NJ
Zip	:	07095-1003
Country	:	US
Telephone Number	:	201-801-7141
Fax Number	:

Provider Business Practice Location Address
First Line	:	1243 WOODROW RD STE 321
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-1725
Country	:	US
Telephone Number	:	201-801-7141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	03/08/2019

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Directions to “ KAYLA CASTRO ” Practice Location

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