Provider Demographics
NPI:1316966609
Name:ICASAS, JOSE (PT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ICASAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W 57TH ST
Mailing Address - Street 2:SUITE 1702
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2802
Mailing Address - Country:US
Mailing Address - Phone:212-757-1157
Mailing Address - Fax:212-757-7197
Practice Address - Street 1:57 W 57TH ST
Practice Address - Street 2:SUITE 1702
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-757-1157
Practice Address - Fax:212-757-7197
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist