Provider Demographics
NPI:1659982874
Name:MISTALSKI, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MISTALSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9753 E CELTIC DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1408
Mailing Address - Country:US
Mailing Address - Phone:480-543-7330
Mailing Address - Fax:
Practice Address - Street 1:9753 E CELTIC DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1408
Practice Address - Country:US
Practice Address - Phone:480-543-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist