Healthcare Provider Details

I. General information

NPI: 1841115441
Provider Name (Legal Business Name): HALEY MARIE MASTROBERTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY MARIE OQUENDO-ESCOBAR

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21760 STATE ROAD 54 STE 102
LUTZ FL
33549-6944
US

IV. Provider business mailing address

32796 SAND CREEK DR
WESLEY CHAPEL FL
33543-4485
US

V. Phone/Fax

Practice location:
  • Phone: 813-252-0561
  • Fax:
Mailing address:
  • Phone: 201-414-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number45209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: