Provider Demographics
NPI:1912120833
Name:DECASTRO, ELEANORA E (PT)
Entity Type:Individual
Prefix:
First Name:ELEANORA
Middle Name:E
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 SUDBURY CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4012
Mailing Address - Country:US
Mailing Address - Phone:321-945-5229
Mailing Address - Fax:407-282-8875
Practice Address - Street 1:4912 SUDBURY CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4012
Practice Address - Country:US
Practice Address - Phone:321-945-5229
Practice Address - Fax:407-282-8875
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist