Provider Demographics
NPI:1609024439
Name:CASTANEDA, GLENDA MARIE (PT)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:MARIE
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GLENDA MARIE
Other - Middle Name:TUMANGAN
Other - Last Name:CERVANTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:123 HOME ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2705
Mailing Address - Country:US
Mailing Address - Phone:516-343-0867
Mailing Address - Fax:516-837-9861
Practice Address - Street 1:123 HOME ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2705
Practice Address - Country:US
Practice Address - Phone:516-343-0867
Practice Address - Fax:516-837-0861
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352182071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist