Provider Demographics
NPI:1649598954
Name:NASTA, KATHLEEN A (DPT)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:NASTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LEARY LN
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1810
Mailing Address - Country:US
Mailing Address - Phone:631-560-9346
Mailing Address - Fax:631-724-1593
Practice Address - Street 1:51 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3603
Practice Address - Country:US
Practice Address - Phone:631-382-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033524-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics