Healthcare Provider Details

I. General information

NPI: 1710777388
Provider Name (Legal Business Name): MYLINA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SAINT BERNARDINE ST
READING PA
19607-1737
US

IV. Provider business mailing address

1222 ROBESON ST
READING PA
19604-2147
US

V. Phone/Fax

Practice location:
  • Phone: 610-796-5018
  • Fax:
Mailing address:
  • Phone: 484-644-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT008900
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: