Healthcare Provider Details

I. General information

NPI: 1629886775
Provider Name (Legal Business Name): ARIANA TERESA ANTONIO PT, DPT, SCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 SHADELANDS DR
WALNUT CREEK CA
94598-2494
US

IV. Provider business mailing address

20800 LAKE CHABOT RD APT 324
CASTRO VALLEY CA
94546-5437
US

V. Phone/Fax

Practice location:
  • Phone: 925-979-4000
  • Fax:
Mailing address:
  • Phone: 669-238-5421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number302569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: