Provider Demographics
NPI:1306850649
Name:ANTOVICH, CAROL A (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:ANTOVICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9156 ELK GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2013
Mailing Address - Country:US
Mailing Address - Phone:916-684-4100
Mailing Address - Fax:916-684-5299
Practice Address - Street 1:9156 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2013
Practice Address - Country:US
Practice Address - Phone:916-684-4100
Practice Address - Fax:916-684-5299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 13470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist