MEDICARE: MOIRA KELCEY CASTALDI DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT027499	PA

General Provider Information

NPI Number	:	1114480084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOIRA KELCEY CASTALDI DPT

Provider Business Mailing Address
First Line	:	350 NEW FIDELITY CT
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-2665
Country	:	US
Telephone Number	:	570-842-9323
Fax Number	:	570-842-9362

Provider Business Practice Location Address
First Line	:	2591 ROUTE 6 STE 202
Second Line	:
City	:	HAWLEY
State	:	PA
Zip	:	18428-7062
Country	:	US
Telephone Number	:	570-226-5680
Fax Number	:	570-226-5682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	04/21/2021

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