Provider Demographics
NPI:1235341868
Name:MUSETTI, MICHELLE MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIE
Last Name:MUSETTI
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 1:48 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-4118
Mailing Address - Country:US
Mailing Address - Phone:631-375-1159
Mailing Address - Fax:
Practice Address - Street 1:225 MONTAUK HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1425
Practice Address - Country:US
Practice Address - Phone:631-878-7012
Practice Address - Fax:631-878-7015
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020627-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist