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General NPI Number Information
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NPI Number | 1851052138
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Entity Type | Individual
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Provider Name | CRAIG ANTLEY LMT
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Gender | Male
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 1810 NW 6TH ST STE B
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City | GAINESVILLE
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State | FL
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Zip | 32609-8535
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Country | US
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Telephone | 843-901-9177
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 SW 10TH TER APT 20
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City | GAINESVILLE
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State | FL
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Zip | 32601-7874
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Country | US
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Telephone | 843-901-9177
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA98683
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License Number State | FL
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