Provider Demographics
NPI:1083258560
Name:DANTZIG, ANITA (DPT, CHT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:DANTZIG
Suffix:
Gender:F
Credentials:DPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TECHNOLOGY DR STE 5
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3469
Mailing Address - Country:US
Mailing Address - Phone:631-444-4210
Mailing Address - Fax:631-444-4764
Practice Address - Street 1:14 TECHNOLOGY DR STE 5
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3469
Practice Address - Country:US
Practice Address - Phone:631-444-4210
Practice Address - Fax:631-444-4764
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014350-12251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand