Provider Demographics
NPI:1376643460
Name:ANTONELLI, LYNN M (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:M
Last Name:ANTONELLI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:14125 NORTHERN BLVD
Mailing Address - Street 2:APT. F4
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4248
Mailing Address - Country:US
Mailing Address - Phone:718-358-0451
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:11TH FLOOR PHYSICAL THERAPY SUITE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-518-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011742-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist