MEDICARE: JENNIFER LYNN ANTONELLI 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	43026	CA
2	225100000X	Physical Therapist	PT020186	PA

General Provider Information

NPI Number	:	1912244047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN ANTONELLI DPT

Provider Business Mailing Address
First Line	:	211 OCTOBER DR
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16002-7551
Country	:	US
Telephone Number	:	814-414-8452
Fax Number	:

Provider Business Practice Location Address
First Line	:	9100 BABCOCK BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-5815
Country	:	US
Telephone Number	:	412-367-6700
Fax Number	:

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

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	04/09/2026

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