Provider Demographics
NPI:1811107576
Name:ACIERTO, MALCOLM BASINILLO (RPT)
Entity type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:BASINILLO
Last Name:ACIERTO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 NE CHIPMAN RD APT 92
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2583
Mailing Address - Country:US
Mailing Address - Phone:773-780-7669
Mailing Address - Fax:
Practice Address - Street 1:1600 SOUTH KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:816-833-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006024392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist