Provider Demographics
NPI:1821343245
Name:CASTELLVI, CHERRY
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:
Last Name:CASTELLVI
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 1:2817 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1746
Mailing Address - Country:US
Mailing Address - Phone:917-741-4754
Mailing Address - Fax:810-454-2911
Practice Address - Street 1:2817 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1746
Practice Address - Country:US
Practice Address - Phone:917-741-4754
Practice Address - Fax:810-454-2911
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012214-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist