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General NPI Number Information
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NPI Number | 1194523167
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Entity Type | Individual
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Provider Name | LUIZ ISMAEL DE CASTRO JUNIOR PT
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Gender | Male
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 19801 HAMPTON DR # C3
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City | BOCA RATON
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State | FL
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Zip | 33434-2840
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Country | US
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Telephone | 561-576-3101
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Fax |
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Provider Business Mailing Address
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Address Line | 22485 SW 61ST WAY
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City | BOCA RATON
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State | FL
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Zip | 33428-6331
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Country | US
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Telephone | 754-777-1972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT35695
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License Number State | FL
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