MEDICARE: LUIS V CASTRO 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	PT6262	MS

General Provider Information

NPI Number	:	1609385814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS V CASTRO PT

Provider Business Mailing Address
First Line	:	PO BOX 2153 DEPT 1947
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35287-1689
Country	:	US
Telephone Number	:	901-227-3255
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 N JERRY CLOWER BLVD STE M
Second Line	:
City	:	YAZOO CITY
State	:	MS
Zip	:	39194-8669
Country	:	US
Telephone Number	:	662-763-3750
Fax Number	:	662-763-3721

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

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	06/03/2021

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Directions to “ LUIS V CASTRO PT” Practice Location

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