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General NPI Number Information
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NPI Number | 1225177611
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Entity Type | Individual
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Provider Name | RAFAEL MASTOV DPT
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 5970 S JOG RD STE A-1
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City | LAKE WORTH
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State | FL
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Zip | 33467-6590
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Country | US
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Telephone | 561-300-1999
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Fax | 561-300-1990
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Provider Business Mailing Address
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Address Line | 6360 98TH ST APT A3
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City | REGO PARK
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State | NY
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Zip | 11374-2223
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 029091
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT35434
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License Number State | FL
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