Provider Demographics
NPI:1194933994
Name:MASTRANGELO, M. ALYSIA (PT)
Entity type:Individual
Prefix:DR
First Name:M. ALYSIA
Middle Name:
Last Name:MASTRANGELO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CANDLE CT
Mailing Address - Street 2:
Mailing Address - City:SHAMONG
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8407
Mailing Address - Country:US
Mailing Address - Phone:609-268-9179
Mailing Address - Fax:
Practice Address - Street 1:1561 ROUTE 38
Practice Address - Street 2:SUITE 5
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2939
Practice Address - Country:US
Practice Address - Phone:609-828-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00621500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist