MEDICARE: BART CASTILLO ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1932640927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BART CASTILLO ATC

Provider Business Mailing Address
First Line	:	7 W CAMPBELL ST
Second Line	:	APT 15
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 W CAMPBELL ST
Second Line	:	APT 15
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1448
Country	:	US
Telephone Number	:	224-632-3113
Fax Number	:

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

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	03/10/2017

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