Provider Demographics
NPI:1356400709
Name:ASCHETTINO, RAYMOND ANTHONY (PT)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ANTHONY
Last Name:ASCHETTINO
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 1:1470 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3918
Mailing Address - Country:US
Mailing Address - Phone:419-991-3151
Mailing Address - Fax:
Practice Address - Street 1:3063 W ELM ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2514
Practice Address - Country:US
Practice Address - Phone:419-999-1105
Practice Address - Fax:419-999-1677
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000189894OtherANTHEM INDIV.PIN-LIMA
OH000000298666OtherANTHEM INDIV.PIN-SIDNEY
OH000000028028OtherANTHEM INDIV PIN-PIQUA
OH0692862Medicaid
OH000000189894OtherANTHEM INDIV.PIN-LIMA
OHAS0608747Medicare ID - Type UnspecifiedMED.PROV#-PIQUA
OHAS0608746Medicare ID - Type UnspecifiedMED.PROV#-SIDNEY