Provider Demographics
NPI:1891848677
Name:NICASTRO, MONICA NICOLE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:NICOLE
Last Name:NICASTRO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 1ST CAPITOL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2880
Mailing Address - Country:US
Mailing Address - Phone:636-947-5467
Mailing Address - Fax:636-949-7084
Practice Address - Street 1:400 1ST CAPITOL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2880
Practice Address - Country:US
Practice Address - Phone:636-947-5467
Practice Address - Fax:636-949-7084
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001007191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO215534741Medicare PIN