Healthcare Provider Details

I. General information

NPI: 1851756902
Provider Name (Legal Business Name): MICHELLE MUSETTI PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MONTAUK HWY SUITE 109
MORICHES NY
11955-1425
US

IV. Provider business mailing address

225 MONTAUK HWY SUITE 109
MORICHES NY
11955-1425
US

V. Phone/Fax

Practice location:
  • Phone: 631-878-7012
  • Fax: 631-878-7015
Mailing address:
  • Phone: 631-878-7012
  • Fax: 631-878-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number020627-1
License Number StateNY

VIII. Authorized Official

Name: MICHELLE SATUR
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-878-7012