Provider Demographics
NPI:1336573450
Name:MUSCATELLO, LISA ANN (ATC, PTA, CSCS)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:MUSCATELLO
Suffix:
Gender:F
Credentials:ATC, PTA, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2906
Mailing Address - Country:US
Mailing Address - Phone:518-583-8383
Mailing Address - Fax:518-580-2272
Practice Address - Street 1:3040 ROUTE 50
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2906
Practice Address - Country:US
Practice Address - Phone:518-583-8383
Practice Address - Fax:518-580-2272
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006952-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant