Healthcare Provider Details

I. General information

NPI: 1689368870
Provider Name (Legal Business Name): JADE MARIE CASTILLO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 PASADENA AVE S
SOUTH PASADENA FL
33707-3717
US

IV. Provider business mailing address

319 52ND ST W
PALMETTO FL
34221-6706
US

V. Phone/Fax

Practice location:
  • Phone: 727-527-5272
  • Fax:
Mailing address:
  • Phone: 941-822-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA31308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: