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Individual
MR. MICHAEL MASTROSTEFANO
Active
Individual
MR. MICHAEL MASTROSTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, OCS, MTC
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305003855
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010066913
FIRST HEALTH MEDICAID
VA
01
—
194012
ANTHEM
VA
01
—
346761200
US DEPT.F LABOR
VA
01
—
487998
NCPPO
VA
01
—
7145603
MAMSI
VA
01
—
8367-0001
CAREFIRST BC/BS
VA
01
—
G00957
MEDICARE PTAN
VA
Enumeration date
10/14/2005
Last updated
05/17/2019
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