MEDICARE: DANIEL M. ANTONINO PROF. CORP.

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	2251X0800X	Orthopedic Physical Therapist	0669	NV

General Provider Information

NPI Number	:	1306030622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL M. ANTONINO PROF. CORP.

Provider Business Mailing Address
First Line	:	7955 W SAHARA AVE
Second Line	:	SUITE #103
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7910
Country	:	US
Telephone Number	:	702-233-3288
Fax Number	:	702-233-2369

Provider Business Practice Location Address
First Line	:	7955 W SAHARA AVE
Second Line	:	SUITE #103
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7910
Country	:	US
Telephone Number	:	702-233-3288
Fax Number	:	702-233-2369

Authorized Official
Title or Position	:	OWNER, CEO, SECRETARY
Name	:	MR. DANIEL MARIO ANTONINO
Credential	:	PT, OCS
Telephone Number	:	702-233-3288

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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