Provider Demographics
NPI:1033756747
Name:ANTONIOLI, CLARE JOJAMETTE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CLARE
Middle Name:JOJAMETTE
Last Name:ANTONIOLI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5907 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-3340
Mailing Address - Country:US
Mailing Address - Phone:406-214-8326
Mailing Address - Fax:
Practice Address - Street 1:2965 STOCKYARD RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1557
Practice Address - Country:US
Practice Address - Phone:406-541-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016558225100000X
WAPT61000015225100000X
MTPTP-PT-LIC-17280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist