Provider Demographics
NPI:1740970532
Name:CASTRO, ANDREA GABRIELA (DPT)
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:GABRIELA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SE DUPONT ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6723
Mailing Address - Country:US
Mailing Address - Phone:772-807-2429
Mailing Address - Fax:
Practice Address - Street 1:10198 SW VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2594
Practice Address - Country:US
Practice Address - Phone:772-879-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist