Provider Demographics
NPI:1144817578
Name:CASTILLO, DOLLOR CARLO MANALO
Entity type:Individual
Prefix:
First Name:DOLLOR CARLO
Middle Name:MANALO
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-8763
Mailing Address - Country:US
Mailing Address - Phone:541-868-6722
Mailing Address - Fax:
Practice Address - Street 1:2300 WARREN ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1116
Practice Address - Country:US
Practice Address - Phone:541-686-2828
Practice Address - Fax:541-242-5670
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist