MEDICARE: MS. JAMIE SHANNON CASTIL M.P.T

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	27723	CA

General Provider Information

NPI Number	:	1457583478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMIE SHANNON CASTIL M.P.T

Provider Business Mailing Address
First Line	:	2373 AMBER OAK LN
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92027-6724
Country	:	US
Telephone Number	:	951-640-9412
Fax Number	:

Provider Business Practice Location Address
First Line	:	42080 STATE ST
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-5173
Country	:	US
Telephone Number	:	760-568-2894
Fax Number	:

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

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	08/10/2009

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