Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 040158 | NY |
NPI | 1013533736 |
---|---|
Provider Name | Miss Pearl Abigail Jumantoc Castro |
First Address | New York, NY 10038-2535 |
Second Address | New York, NY 10038-2535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2020 |
Last Update Date | 18/06/2020 |