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NPI Code Detail

MEDICARE: LEIAH ROXANN CASTILLO LMT

MEDICARE: LEIAH ROXANN CASTILLO LMT
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
1225700000XMassage Therapist11856SC

General Provider Information

NPI Number : 1962046748
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEIAH ROXANN CASTILLO LMT
Provider Business Mailing Address
First Line : 109 MOORING BUOY
Second Line :
City : HILTON HEAD ISLAND
State : SC
Zip : 29928-5223
Country : US
Telephone Number : 843-301-1345
Fax Number :
Provider Business Practice Location Address
First Line : 113 WAPPOO CREEK DR STE 2
Second Line :
City : CHARLESTON
State : SC
Zip : 29412-2136
Country : US
Telephone Number : 843-301-1345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2019
Last Update Date : 05/24/2021

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Directions to “ LEIAH ROXANN CASTILLO LMT” Practice Location

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