Provider Demographics
NPI:1902053564
Name:DE CASTRO, DHARRIAN J (PT)
Entity Type:Individual
Prefix:MISS
First Name:DHARRIAN
Middle Name:J
Last Name:DE CASTRO
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 1:8422 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4804
Mailing Address - Country:US
Mailing Address - Phone:646-275-9222
Mailing Address - Fax:
Practice Address - Street 1:8422 55TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4804
Practice Address - Country:US
Practice Address - Phone:646-275-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01282900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist