Provider Demographics
NPI:1104941152
Name:CARLOMUSTO, CHRISTA MILENA (MPT)
Entity type:Individual
Prefix:MS
First Name:CHRISTA
Middle Name:MILENA
Last Name:CARLOMUSTO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25450 VILLAGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8041
Mailing Address - Country:US
Mailing Address - Phone:248-308-0400
Mailing Address - Fax:
Practice Address - Street 1:25450 VILLAGEWOOD CT
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-8041
Practice Address - Country:US
Practice Address - Phone:248-308-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2066225100000X
MI5501016036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist