MEDICARE: ANTONIO JI FOX PT, DPT

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
1	225100000X	Physical Therapist	PT010442	GA

General Provider Information

NPI Number	:	1053696799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO JI FOX PT, DPT

Provider Business Mailing Address
First Line	:	12 ANASTASIA DR SE
Second Line	:
City	:	MABLETON
State	:	GA
Zip	:	30126-1461
Country	:	US
Telephone Number	:	770-870-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1995 N PARK PL SE STE 519
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-7801
Country	:	US
Telephone Number	:	770-989-1405
Fax Number	:	770-907-5746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2011
Last Update Date	:	12/04/2023

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