MEDICARE: KARA RASTELLO

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	5502003328	MI

General Provider Information

NPI Number	:	1598016081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA RASTELLO

Provider Business Mailing Address
First Line	:	1234 E BROOMFIELD ST
Second Line	:	A3
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-4491
Country	:	US
Telephone Number	:	989-773-1333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 E BROOMFIELD ST
Second Line	:	A3
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-4491
Country	:	US
Telephone Number	:	989-773-1333
Fax Number	:

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

Provider Enumeration Date	:	09/25/2012
Last Update Date	:	09/25/2012

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Directions to “ KARA RASTELLO ” Practice Location

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