Provider Demographics
NPI:1346718970
Name:CASTILLO, KAITLIN (PT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 HOOT OWL LN S
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2589
Mailing Address - Country:US
Mailing Address - Phone:737-255-2554
Mailing Address - Fax:737-263-2311
Practice Address - Street 1:404 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3165
Practice Address - Country:US
Practice Address - Phone:737-255-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1313082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1313082Medicaid