Provider Demographics
NPI:1457340283
Name:MASTROSTEFANO, MICHAEL (PT, OCS, MTC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MASTROSTEFANO
Suffix:
Gender:M
Credentials:PT, OCS, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 EAST JEFFERSON ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3567
Mailing Address - Country:US
Mailing Address - Phone:703-237-2000
Mailing Address - Fax:703-237-2155
Practice Address - Street 1:80 EAST JEFFERSON ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3567
Practice Address - Country:US
Practice Address - Phone:703-237-2000
Practice Address - Fax:703-237-2155
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00957OtherMEDICARE PTAN
VA8367-0001OtherCAREFIRST BC/BS
VA010066913OtherFIRST HEALTH MEDICAID
VA194012OtherANTHEM
VA346761200OtherUS DEPT.F LABOR
VA487998OtherNCPPO
VA7145603OtherMAMSI
VA7145603OtherMAMSI