Provider Demographics
NPI:1336513027
Name:ALCANTARA, CAROLINA DE CASTRO (PT)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:DE CASTRO
Last Name:ALCANTARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1662
Mailing Address - Country:US
Mailing Address - Phone:954-630-3131
Mailing Address - Fax:954-630-3132
Practice Address - Street 1:2655 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1662
Practice Address - Country:US
Practice Address - Phone:954-630-3131
Practice Address - Fax:954-630-3132
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30086225100000X
FLMA66172225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist