Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | DC-7102-L | PA |
N | 225100000X | Physical Therapist | PT-710212 | NY |
NPI | 1306815568 |
---|---|
Provider Name | Dr. Matt Nicastro |
First Address | Carlisle, PA 17013-4240 |
Second Address | Carlisle, PA 17013-4240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01751094-01 | (05) | PA |
U73642 | (02) | PA |