Provider Demographics
NPI:1275615916
Name:ANTONINO, DANIEL MARIO (PT,OCS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MARIO
Last Name:ANTONINO
Suffix:
Gender:M
Credentials:PT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7955 W SAHARA AVE
Mailing Address - Street 2:#103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7910
Mailing Address - Country:US
Mailing Address - Phone:702-233-3288
Mailing Address - Fax:702-233-2369
Practice Address - Street 1:7955 W SAHARA AVE
Practice Address - Street 2:#103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7910
Practice Address - Country:US
Practice Address - Phone:702-233-3288
Practice Address - Fax:702-233-2369
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP54337Medicare UPIN
NVV36194Medicare ID - Type Unspecified