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NPI Code Detail

MEDICARE: MS. MARIA ANTONETTI LPTA13089

MEDICARE: MS. MARIA ANTONETTI LPTA13089
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA13089FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1106898OTHERFLMEDICARE ID

General Provider Information

NPI Number : 1003050600
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIA ANTONETTI LPTA13089
Provider Business Mailing Address
First Line : 11242 SCENIC VISTA DR
Second Line :
City : CLERMONT
State : FL
Zip : 34711-8669
Country : US
Telephone Number : 352-247-5737
Fax Number :
Provider Business Practice Location Address
First Line : 394 N SUNCOAST BLVD STE 40
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-5466
Country : US
Telephone Number : 352-795-6225
Fax Number : 352-795-6065
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2009
Last Update Date : 11/15/2019

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