Provider Demographics
NPI:1619158540
Name:CASTRONUEVO, KAREN ANNE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:CASTRONUEVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2613
Mailing Address - Country:US
Mailing Address - Phone:646-269-5723
Mailing Address - Fax:
Practice Address - Street 1:7609 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2613
Practice Address - Country:US
Practice Address - Phone:646-269-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist