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General NPI Number Information
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NPI Number | 1538433420
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Entity Type | Individual
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Provider Name | MICHAEL ANTUNES DPT
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Gender | Male
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 27 DEPOT ST
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City | WATERTOWN
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State | CT
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Zip | 06795-2601
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Country | US
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Telephone | 860-274-1487
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Fax | 860-274-9730
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Provider Business Mailing Address
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Address Line | 47 N MAIN ST SUITE 303
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1926
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Country | US
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Telephone | 860-409-4595
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Fax | 860-409-4860
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9314
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License Number State | CT
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