Basic Information
| Provider Information | |||||||||
| NPI: | 1801472865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASTELLONE | ||||||||
| FirstName: | CRISTINA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 CHICKORY CT | ||||||||
| Address2: | |||||||||
| City: | GLEN ARM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210579122 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 620 W MACPHAIL RD | ||||||||
| Address2: | |||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103999590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2021 | ||||||||
| LastUpdateDate: | 06/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 225200000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.