Provider Demographics
NPI:1861603243
Name:EDO, RODRIGO DEL CASTILLO (RPT)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:DEL CASTILLO
Last Name:EDO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8616 WEST TENTH STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234
Mailing Address - Country:US
Mailing Address - Phone:317-209-2332
Mailing Address - Fax:
Practice Address - Street 1:8616 WEST TENTH STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234
Practice Address - Country:US
Practice Address - Phone:317-209-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008643A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist