=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568520310
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT CASTORINA PT, DPT, MS, ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 11/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 861 BEDFORD RD GOLDSTEIN HEALTH & FITNESS CENTER, SUITE 124
-----------------------------------------------------
City | PLEASANTVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10570-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-747-1112
-----------------------------------------------------
Fax | 914-747-1114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 861 BEDFORD RD GOLDSTEIN HEALTH & FITNESS CENTER, SUITE 124
-----------------------------------------------------
City | PLEASANTVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10570-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-747-1112
-----------------------------------------------------
Fax | 914-747-1114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 018508
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 018508
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 069502483
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------