Provider Demographics
NPI:1790897619
Name:DE CASTRO, STEVEN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:DE CASTRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BURDICK LN
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-2229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:495 GOLD STAR HIGHWAY
Practice Address - Street 2:SUITE 112
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6229
Practice Address - Country:US
Practice Address - Phone:860-446-8254
Practice Address - Fax:860-446-8293
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080007620CT08OtherBLUE CROSS BLUE SHIELD
CT080007620CT09OtherBLUE SHIELD
CT080007620CT10OtherBLUE SHIELD
CT080007620CT07OtherBLUE CROSS BLUE SHIELD