Provider Demographics
NPI:1003001140
Name:NICASTRO, JON (PT)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:NICASTRO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N STEPHANIE ST STE 310
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6608
Mailing Address - Country:US
Mailing Address - Phone:575-636-7434
Mailing Address - Fax:
Practice Address - Street 1:400 N STEPHANIE ST STE 310
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6608
Practice Address - Country:US
Practice Address - Phone:575-636-7434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4491225100000X
NV3156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA-0560OtherPTA LICENSE