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NPI Code Detail

MEDICARE: NICASTOR ANOTADO JR PT

MEDICARE: NICASTOR ANOTADO JR PT
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
1225100000XPhysical Therapist24389MD

General Provider Information

NPI Number : 1861883472
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICASTOR ANOTADO JR PT
Provider Business Mailing Address
First Line : 23500 S PATUXENT BEACH RD
Second Line :
City : CALIFORNIA
State : MD
Zip : 20619-4213
Country : US
Telephone Number : 954-822-4304
Fax Number :
Provider Business Practice Location Address
First Line : 11100 ASBURY CIR
Second Line :
City : SOLOMONS
State : MD
Zip : 20688-3004
Country : US
Telephone Number : 410-394-3066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2015
Last Update Date : 02/18/2015

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