Provider Demographics
NPI:1780608810
Name:LOCASTRO, ANGELO (PT)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:LOCASTRO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CONGRESS PARK DR STE 125
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4664
Mailing Address - Country:US
Mailing Address - Phone:561-789-1633
Mailing Address - Fax:561-819-6311
Practice Address - Street 1:220 CONGRESS PARK DR STE 125
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4664
Practice Address - Country:US
Practice Address - Phone:561-789-1633
Practice Address - Fax:561-819-6311
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1780608810OtherNPI #
FLAA460ZMedicare PIN