Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT22747 | FL |
NPI | 1003082710 |
---|---|
Provider Name | Michelle Senia Antonio |
First Address | Jacksonville, FL 32244-8536 |
Second Address | Jacksonville, FL 32207-8202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2008 |
Last Update Date | 02/05/2008 |