Provider Demographics
NPI:1861695223
Name:GIUMETTI, MICHAEL ALBERT (PTA LICENSE)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALBERT
Last Name:GIUMETTI
Suffix:
Gender:M
Credentials:PTA LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 VALLEY AVE APT 56
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1661
Mailing Address - Country:US
Mailing Address - Phone:609-704-9585
Mailing Address - Fax:
Practice Address - Street 1:535 EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2335
Practice Address - Country:US
Practice Address - Phone:856-582-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00181600225200000X
PATE005708L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant