MEDICARE: MS. SANDRA PATRICIA CASTILLO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	016556-1	NY
2	225100000X	Physical Therapist	PT7879	FL

General Provider Information

NPI Number	:	1316192404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA PATRICIA CASTILLO PT

Provider Business Mailing Address
First Line	:	474 48TH AVE APT 12J
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5612
Country	:	US
Telephone Number	:	718-937-0809
Fax Number	:

Provider Business Practice Location Address
First Line	:	474 48TH AVE APT 12J
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5612
Country	:	US
Telephone Number	:	718-937-0809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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