Provider Demographics
NPI:1649604240
Name:MAGISTRO, BEN THOMAS (LMT)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:THOMAS
Last Name:MAGISTRO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2569 FROST RD
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-9132
Mailing Address - Country:US
Mailing Address - Phone:216-548-7752
Mailing Address - Fax:
Practice Address - Street 1:2569 FROST RD
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255-9132
Practice Address - Country:US
Practice Address - Phone:216-548-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.019773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist