Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA13089 | FL |
NPI | 1003050600 |
---|---|
Provider Name | Ms. Maria Antonetti |
First Address | Clermont, FL 34711-8669 |
Second Address | Crystal River, FL 34429-5466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2009 |
Last Update Date | 15/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106898 | MEDICARE ID (01) | FL |