Provider Demographics
NPI:1780229724
Name:NACATAB, CAMILO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CAMILO
Middle Name:
Last Name:NACATAB
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 57TH RD FL 3
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4841
Mailing Address - Country:US
Mailing Address - Phone:347-437-9244
Mailing Address - Fax:
Practice Address - Street 1:3226 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2655
Practice Address - Country:US
Practice Address - Phone:718-252-9100
Practice Address - Fax:718-252-9401
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist