Provider Demographics
NPI:1467820407
Name:GASTALDO, MARIO ANGELO (DPT)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ANGELO
Last Name:GASTALDO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-3125
Mailing Address - Country:US
Mailing Address - Phone:440-223-6677
Mailing Address - Fax:
Practice Address - Street 1:9119 FOREST LN
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-3125
Practice Address - Country:US
Practice Address - Phone:440-223-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT016030OtherPTOTAT BOARD: PHYSICAL THERAPY LICENCE