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General NPI Number Information
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NPI Number | 1114704756
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Entity Type | Organization
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Legal Business Name | OLIVIA CASTILLO PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 11417 CULVER BLVD APT 2
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City | LOS ANGELES
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State | CA
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Zip | 90066
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Country | US
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Telephone | 310-929-0103
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Fax |
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Provider Business Mailing Address
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Address Line | 10866 WASHINGTON BLVD # 418
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City | CULVER CITY
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State | CA
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Zip | 90232-3610
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Country | US
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Telephone | 310-929-0103
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | OLIVIA ANN CASTILLO
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Credential | PT, DPT, OCS, CMPT
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Telephone | 310-929-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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