Provider Demographics
NPI:1003050600
Name:ANTONETTI, MARIA (LPTA13089)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:ANTONETTI
Suffix:
Gender:F
Credentials:LPTA13089
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:ANTONETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPTA13089
Mailing Address - Street 1:11242 SCENIC VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8669
Mailing Address - Country:US
Mailing Address - Phone:352-247-5737
Mailing Address - Fax:
Practice Address - Street 1:394 N SUNCOAST BLVD STE 40
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-5466
Practice Address - Country:US
Practice Address - Phone:352-795-6225
Practice Address - Fax:352-795-6065
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA13089225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106898OtherMEDICARE ID