Healthcare Provider Details

I. General information

NPI: 1003050600
Provider Name (Legal Business Name): MARIA ANTONETTI LPTA13089
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA ANTONETTI LPTA13089

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 N SUNCOAST BLVD STE 40
CRYSTAL RIVER FL
34429-5466
US

IV. Provider business mailing address

11242 SCENIC VISTA DR
CLERMONT FL
34711-8669
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-6225
  • Fax: 352-795-6065
Mailing address:
  • Phone: 352-247-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA13089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: