Provider Demographics
NPI:1497110472
Name:CASTELLANO, JOHANNA S (PT)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:S
Last Name:CASTELLANO
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 1:340 PLAD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2625
Mailing Address - Country:US
Mailing Address - Phone:631-835-8914
Mailing Address - Fax:
Practice Address - Street 1:340 PLAD BLVD
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2625
Practice Address - Country:US
Practice Address - Phone:631-835-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist