Provider Demographics
NPI:1063490829
Name:CASTELLANO, DANIELLE LISA (RPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LISA
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:LISA
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:544 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4401
Mailing Address - Country:US
Mailing Address - Phone:203-937-6150
Mailing Address - Fax:203-937-8517
Practice Address - Street 1:544 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4401
Practice Address - Country:US
Practice Address - Phone:203-937-6150
Practice Address - Fax:203-937-8517
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080006548CT01OtherANTHEM BCBS
P00237191OtherRAILROAD MEDICARE