Provider Demographics
NPI:1164553517
Name:DEAN, ANTONIA LEE CHRISTINA (DPT)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:LEE CHRISTINA
Last Name:DEAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANTONIA
Other - Middle Name:
Other - Last Name:BALOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-258-3900
Mailing Address - Fax:425-258-3910
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-339-5419
Practice Address - Fax:360-659-6615
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8465544Medicaid
WA1003978Medicaid
WA8465544Medicaid