Provider Demographics
NPI:1477835262
Name:PATLYEK, ANTHONY LEO (LMT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LEO
Last Name:PATLYEK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5484 LAKE MARGARET DRIVE
Mailing Address - Street 2:APT. 1716
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-6162
Mailing Address - Country:US
Mailing Address - Phone:219-308-5780
Mailing Address - Fax:
Practice Address - Street 1:5484 LAKE MARGARET DRIVE
Practice Address - Street 2:APT. 1716
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-6162
Practice Address - Country:US
Practice Address - Phone:219-308-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist