MEDICARE: VICTOR ANTON PT

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	225100000X	Physical Therapist	10176	FL

General Provider Information

NPI Number	:	1013917970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR ANTON PT

Provider Business Mailing Address
First Line	:	11809 HOLLYHOCK DR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34202-2040
Country	:	US
Telephone Number	:	941-727-5588
Fax Number	:	941-727-5588

Provider Business Practice Location Address
First Line	:	11809 HOLLYHOCK DR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34202-2040
Country	:	US
Telephone Number	:	941-727-5588
Fax Number	:	941-727-5588

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/09/2007

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Directions to “ VICTOR ANTON PT” Practice Location

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