Provider Demographics
NPI:1497794614
Name:PISCITELLO, MICHAEL J (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:PISCITELLO
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 1:328 THOMAS MORE PKWY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3488
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:859-344-4153
Practice Address - Street 1:328 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3488
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:859-344-4153
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-011470225100000X
OHPT-011470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10759935OtherCAQH
OHPI4185832Medicare PIN
KY023496Medicare PIN
OHH216610Medicare PIN
ILK24155Medicare UPIN
OH10759935OtherCAQH