Provider Demographics
NPI:1902536303
Name:CASTELA, ELIZABETH J (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:J
Last Name:CASTELA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6262 E BROWN RD UNIT 24
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4845
Mailing Address - Country:US
Mailing Address - Phone:720-236-9716
Mailing Address - Fax:
Practice Address - Street 1:41125 N DAISY MOUNTAIN DR STE 121
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-4964
Practice Address - Country:US
Practice Address - Phone:623-551-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-013982225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant