MEDICARE: ROSETTE MUTAS AVILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	011726	NY

General Provider Information

NPI Number	:	1578209474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSETTE MUTAS AVILES

Provider Business Mailing Address
First Line	:	1305 KENWOOD DR
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-3707
Country	:	US
Telephone Number	:	215-650-1654
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 GRAND ISLAND BLVD
Second Line	:
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-1251
Country	:	US
Telephone Number	:	716-773-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2022
Last Update Date	:	05/12/2022

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Directions to “ ROSETTE MUTAS AVILES ” Practice Location

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