Provider Demographics
NPI:1144063942
Name:GASTALI, RAPHAEL MILAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:MILAN
Last Name:GASTALI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 N 168TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2615
Mailing Address - Country:US
Mailing Address - Phone:402-709-9941
Mailing Address - Fax:
Practice Address - Street 1:10730 PACIFIC ST STE 210
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4761
Practice Address - Country:US
Practice Address - Phone:402-753-7230
Practice Address - Fax:402-932-4926
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist