MEDICARE: ROSELLE SANTOS ANTIKOLL

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	7027	NV

General Provider Information

NPI Number	:	1558957340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELLE SANTOS ANTIKOLL

Provider Business Mailing Address
First Line	:	10867 VEMOA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3896
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10867 VEMOA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3896
Country	:	US
Telephone Number	:	702-776-5129
Fax Number	:

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

Provider Enumeration Date	:	12/15/2020
Last Update Date	:	06/17/2026

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Directions to “ ROSELLE SANTOS ANTIKOLL ” Practice Location

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