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General NPI Number Information
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NPI Number | 1639365125
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Entity Type | Individual
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Provider Name | JOHN RICHARD ANTONI P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 4800 S WHITE MOUNTAIN RD SUITE A
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City | SHOW LOW
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State | AZ
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Zip | 85901-7876
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Country | US
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Telephone | 928-537-8766
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Fax | 928-537-8786
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Provider Business Mailing Address
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Address Line | 4800 S WHITE MOUNTAIN RD SUITE A
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City | SHOW LOW
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State | AZ
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Zip | 85901-7876
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Country | US
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Telephone | 928-537-8766
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Fax | 928-537-8786
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2451
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License Number State | AZ
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