Provider Demographics
NPI:1699933465
Name:CASTRO, HAZEL (PT)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:CASTRO
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 1:120 SW THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4463
Mailing Address - Country:US
Mailing Address - Phone:772-370-8018
Mailing Address - Fax:
Practice Address - Street 1:120 SW THORNHILL DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4463
Practice Address - Country:US
Practice Address - Phone:772-370-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12760225100000X
GAPT007488225100000X
PAPT012256L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist