Provider Demographics
NPI:1366079287
Name:CASTRO, ANDREA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 HARBINGER LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5966
Mailing Address - Country:US
Mailing Address - Phone:214-533-0454
Mailing Address - Fax:
Practice Address - Street 1:3051 HARBINGER LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-5966
Practice Address - Country:US
Practice Address - Phone:214-533-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1328965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist