Provider Demographics
NPI:1437550803
Name:BAES, ANTONIO JR
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:BAES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CEDAR CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7809
Mailing Address - Country:US
Mailing Address - Phone:919-259-7000
Mailing Address - Fax:
Practice Address - Street 1:100 CEDAR CLUB CIR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7809
Practice Address - Country:US
Practice Address - Phone:919-259-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist