Provider Demographics
NPI:1033820170
Name:DADE, ANTIONETTE
Entity Type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:
Last Name:DADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 SOUTH HAARDT DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36105
Mailing Address - Country:US
Mailing Address - Phone:251-525-2271
Mailing Address - Fax:
Practice Address - Street 1:69 SOUTH HAARDT DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36105
Practice Address - Country:US
Practice Address - Phone:251-525-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist