Provider Demographics
NPI:1447076575
Name:CASTILLO, MARY GRACE VILLALON (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MARY GRACE
Middle Name:VILLALON
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
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Other - First Name:
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Mailing Address - Street 1:4367 CONCORD BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1145
Mailing Address - Country:US
Mailing Address - Phone:925-689-7457
Mailing Address - Fax:
Practice Address - Street 1:4367 CONCORD BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-1145
Practice Address - Country:US
Practice Address - Phone:925-689-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA307267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist