Provider Demographics
NPI:1447425624
Name:ANTOINE, MARIE GAETANE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:GAETANE
Last Name:ANTOINE
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 1:10418 203RD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-1320
Mailing Address - Country:US
Mailing Address - Phone:718-776-7907
Mailing Address - Fax:718-776-7907
Practice Address - Street 1:10418 203RD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-1320
Practice Address - Country:US
Practice Address - Phone:718-776-7907
Practice Address - Fax:718-776-7907
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist