Active NPI
Mira Ecila Villamarzo Castillo, PT, DPT, GCS
- Physical Therapist
- Galesburg, IL
National Provider Identifier
1720567985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 280 E Losey St
Galesburg, IL 61401-2819 - Phone
- (309) 343-2166
- NPI assigned
- Aug 8, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
280 E Losey St
Galesburg, IL 61401-2819
Mailing address
1375 N Seminary St Apt 10
Galesburg, IL 61401-2016
Phone (309) 569-6174
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1226793 | TX | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533686400000",
"number": "1720567985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1375 N SEMINARY ST APT 10",
"city": "GALESBURG",
"state": "IL",
"postal_code": "614012016",
"telephone_number": "309-569-6174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 E LOSEY ST",
"city": "GALESBURG",
"state": "IL",
"postal_code": "614012819",
"telephone_number": "309-343-2166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASTILLO",
"first_name": "MIRA ECILA",
"middle_name": "VILLAMARZO",
"credential": "PT, DPT, GCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-08",
"last_updated": "2018-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Galesburg, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.