Provider Demographics
NPI:1275850059
Name:CASTANEDA, SEBASTIAN (PT)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:
Last Name:CASTANEDA
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 1:1553 A ST
Mailing Address - Street 2:APT 414
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5156
Mailing Address - Country:US
Mailing Address - Phone:907-646-7859
Mailing Address - Fax:
Practice Address - Street 1:1553 A ST
Practice Address - Street 2:APT 414
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5156
Practice Address - Country:US
Practice Address - Phone:907-646-7859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist