Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 22482 | MD |
NPI | 1013195619 |
---|---|
Provider Name | Mrs. Janelle Kristen Antonio |
First Address | Elkton, MD 21921-6390 |
Second Address | Elkton, MD 21921-6390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2008 |
Last Update Date | 18/09/2012 |