Provider Demographics
NPI:1962489906
Name:MUSTO, RAPHAEL J (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:J
Last Name:MUSTO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 MAIN ST
Mailing Address - Street 2:CITYLINE PLAZA
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1556
Mailing Address - Country:US
Mailing Address - Phone:570-654-3330
Mailing Address - Fax:
Practice Address - Street 1:1117 MAIN ST
Practice Address - Street 2:CITYLINE PLAZA
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1556
Practice Address - Country:US
Practice Address - Phone:570-654-3330
Practice Address - Fax:570-654-5069
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005435L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01459345Medicaid
PA541584Medicare ID - Type Unspecified