Provider Demographics
NPI:1699167437
Name:CASTRELL, CROFT (CMT, ANMT)
Entity type:Individual
Prefix:
First Name:CROFT
Middle Name:
Last Name:CASTRELL
Suffix:
Gender:M
Credentials:CMT, ANMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 MOORPARK AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1714
Mailing Address - Country:US
Mailing Address - Phone:408-899-4085
Mailing Address - Fax:408-498-9746
Practice Address - Street 1:401 ALBERTO WAY STE 1-6B
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5404
Practice Address - Country:US
Practice Address - Phone:408-401-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56806225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist