Provider Demographics
NPI:1023844768
Name:CASTILLO, ALEX EDUARDO (LMT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:EDUARDO
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557 RAMBLER RD STE 720
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2388
Mailing Address - Country:US
Mailing Address - Phone:214-361-9355
Mailing Address - Fax:
Practice Address - Street 1:8109 SKILLMAN ST APT 3007
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2828
Practice Address - Country:US
Practice Address - Phone:214-533-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT114302225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist