Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3156 | NV |
N | 225100000X | Physical Therapist | 4491 | NM |
NPI | 1003001140 |
---|---|
Provider Name | Mr. Jon Nicastro |
First Address | Henderson, NV 89014-6608 |
Second Address | Henderson, NV 89014-6608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2007 |
Last Update Date | 22/11/2019 |