Provider Demographics
NPI:1013015502
Name:MUSTICH, ROBERT A (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:MUSTICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 ROUTE 88 STE 201
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3044
Mailing Address - Country:US
Mailing Address - Phone:732-840-5770
Mailing Address - Fax:
Practice Address - Street 1:1608 ROUTE 88 STE 201
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3044
Practice Address - Country:US
Practice Address - Phone:732-840-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ2090261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMU584786Medicare ID - Type Unspecified