Provider Demographics
NPI:1013195619
Name:ANTONIO, JANELLE KRISTEN (DPT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:KRISTEN
Last Name:ANTONIO
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Gender:F
Credentials:DPT, OCS
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Mailing Address - Street 1:107 CHESAPEAKE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6390
Mailing Address - Country:US
Mailing Address - Phone:410-392-9400
Mailing Address - Fax:410-392-0577
Practice Address - Street 1:107 CHESAPEAKE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6390
Practice Address - Country:US
Practice Address - Phone:410-392-9400
Practice Address - Fax:410-392-0577
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2012-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD224822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic