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General NPI Number Information
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NPI Number | 1821394701
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Entity Type | Organization
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Legal Business Name | SUSTUS, LLC
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 251 EASTERLY PKWY, BLDG 2
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City | STATE COLLEGE
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State | PA
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Zip | 16801-6301
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Country | US
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Telephone | 814-272-0420
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Fax |
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Provider Business Mailing Address
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Address Line | 251 EASTERLY PKWY BLDG 2
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City | STATE COLLEGE
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State | PA
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Zip | 16801-6301
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Country | US
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Telephone | 814-272-0420
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. JONATHAN MICHEAL MASORTI
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Credential | D.C.
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Telephone | 814-272-0420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 003788L
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License Number State | PA
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