Healthcare Provider Details

I. General information

NPI: 1992078240
Provider Name (Legal Business Name): ANNE JEKKA CASTRO GARCIA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 SAWGRASS CORPORATE PKWY SUITE 100
SUNRISE FL
33323-2859
US

IV. Provider business mailing address

4021 N PINE ISLAND RD SHAMROCK APT.404
SUNRISE FL
33351-6520
US

V. Phone/Fax

Practice location:
  • Phone: 954-739-4247
  • Fax:
Mailing address:
  • Phone: 954-315-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0002813
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: