Provider Demographics
NPI:1275990384
Name:ANTOLINEZ, ERIN SHEA (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:SHEA
Last Name:ANTOLINEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 LONGFELLOW TRL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5178
Mailing Address - Country:US
Mailing Address - Phone:404-632-2336
Mailing Address - Fax:
Practice Address - Street 1:809 S BROAD ST SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-4654
Practice Address - Country:US
Practice Address - Phone:404-632-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003521225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant