Provider Demographics
NPI:1386795748
Name:CASTRO, EDWARD FRANK (PT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:FRANK
Last Name:CASTRO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 ORANGE TREE LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2856
Mailing Address - Country:US
Mailing Address - Phone:909-307-2244
Mailing Address - Fax:909-307-2254
Practice Address - Street 1:1780 ORANGE TREE LN
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2856
Practice Address - Country:US
Practice Address - Phone:909-307-2244
Practice Address - Fax:909-307-2254
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT185250OtherPPIN
CA0PT185250OtherPPIN