Healthcare Provider Details

I. General information

NPI: 1205517596
Provider Name (Legal Business Name): TABITHA CASTILLO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 ISOM RD
SAN ANTONIO TX
78216-4464
US

IV. Provider business mailing address

15349 CHIANTI LN
CORPUS CHRISTI TX
78410-5776
US

V. Phone/Fax

Practice location:
  • Phone: 210-622-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1349467
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: