Provider Demographics
NPI:1790726743
Name:MASITTI, CHERALD ANNE (PT, MS, PCS)
Entity Type:Individual
Prefix:
First Name:CHERALD
Middle Name:ANNE
Last Name:MASITTI
Suffix:
Gender:F
Credentials:PT, MS, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 CONSTITUTION AVE NE
Mailing Address - Street 2:KASEMAN HOSPITAL INPATIENT REHAB SERVICES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7613
Mailing Address - Country:US
Mailing Address - Phone:505-291-2751
Mailing Address - Fax:
Practice Address - Street 1:8300 CONSTITUTION AVE NE
Practice Address - Street 2:KASEMAN HOSPITAL INPATIENT REHAB SERVICES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7613
Practice Address - Country:US
Practice Address - Phone:505-291-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35220317Medicaid