Provider Demographics
NPI:1164477253
Name:T.J. ANTICH, MS,RPT,INC.
Entity Type:Organization
Organization Name:T.J. ANTICH, MS,RPT,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:T.
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANTICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RPT
Authorized Official - Phone:610-935-3500
Mailing Address - Street 1:4 ONEIDA COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-2934
Mailing Address - Country:US
Mailing Address - Phone:610-935-3500
Mailing Address - Fax:610-903-0637
Practice Address - Street 1:4 ONEIDA COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-2934
Practice Address - Country:US
Practice Address - Phone:610-935-3500
Practice Address - Fax:910-903-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001384E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0247446000OtherPA. BLUE CROSS
PA643672OtherPA. BLUE SHIELD
PA643672OtherPA. BLUE SHIELD