Provider Demographics
NPI:1982453908
Name:CASTRO, JOANNE (PTA, LMT, CLT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PTA, LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 FRIAR POST
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-6062
Mailing Address - Country:US
Mailing Address - Phone:814-490-2815
Mailing Address - Fax:
Practice Address - Street 1:8180 BRECKSVILLE RD STE 204
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1353
Practice Address - Country:US
Practice Address - Phone:216-536-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013464225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant