Provider Demographics
NPI:1215134499
Name:LAFUENTE, JASON CASTRO (PT, CEAS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CASTRO
Last Name:LAFUENTE
Suffix:
Gender:M
Credentials:PT, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13998 BRIGHTWATER DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-7181
Mailing Address - Country:US
Mailing Address - Phone:317-525-7438
Mailing Address - Fax:
Practice Address - Street 1:9730 PRAIRIE LAKES BLVD E
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4766
Practice Address - Country:US
Practice Address - Phone:317-770-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008691A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist