Provider Demographics
NPI:1568084796
Name:BELCASTRO, SAMUEL ANTHONY (PTA)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ANTHONY
Last Name:BELCASTRO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MAPLEWOOD DR APT 2105
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9118
Mailing Address - Country:US
Mailing Address - Phone:304-933-3338
Mailing Address - Fax:304-933-3339
Practice Address - Street 1:1000 MAPLEWOOD DR APT 2105
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9118
Practice Address - Country:US
Practice Address - Phone:304-933-3338
Practice Address - Fax:304-933-3339
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPTA001993225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant