Provider Demographics
NPI:1063426690
Name:MAFFUCCI, ROBERT FRANK (MPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANK
Last Name:MAFFUCCI
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 MANHATTAN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1604
Mailing Address - Country:US
Mailing Address - Phone:310-374-0477
Mailing Address - Fax:310-374-1605
Practice Address - Street 1:2621 MANHATTAN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-1604
Practice Address - Country:US
Practice Address - Phone:310-374-0477
Practice Address - Fax:310-374-1605
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT19890OtherPHYSICAL THERAPY LICENSE