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NPI Code Detail

MEDICARE: RALPH ANTHONY ANTONACCI JR. MSPT, ATC, CSCS

MEDICARE: RALPH ANTHONY ANTONACCI JR. MSPT, ATC, CSCS
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
1225100000XPhysical Therapist005212CT
22255A2300XAthletic Trainer

General Provider Information

NPI Number : 1447271846
Entity Type Code : Individual
Provider Name (Legal Business Name) : RALPH ANTHONY ANTONACCI JR. MSPT, ATC, CSCS
Provider Business Mailing Address
First Line : 650 WEST AVE
Second Line :
City : NORWALK
State : CT
Zip : 06850-4020
Country : US
Telephone Number : 203-852-9903
Fax Number : 203-354-2983
Provider Business Practice Location Address
First Line : 650 WEST AVE
Second Line :
City : NORWALK
State : CT
Zip : 06850-4020
Country : US
Telephone Number : 203-852-9903
Fax Number : 203-354-2983
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 09/11/2025

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