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General NPI Number Information
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NPI Number | 1760834352
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Entity Type | Individual
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Provider Name | KAITLIN MARIE ANTONIDES
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Gender | Female
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 8627 CINNAMON CREEK DR BLDG 402
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1480
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Country | US
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Telephone | 830-796-3447
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Fax | 830-796-3685
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Provider Business Mailing Address
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Address Line | 3456 HIGHWAY 16 SOUTH
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City | BANDERA
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State | TX
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Zip | 78003-3599
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Country | US
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Telephone | 830-796-3447
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Fax | 830-796-3685
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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 | 3119382
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License Number State | TX
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