Provider Demographics
NPI:1508097791
Name:PULVER, ANTOINETTE MARIA ELISABETH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:MARIA ELISABETH
Last Name:PULVER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:ANTOINETTE
Other - Middle Name:MARIA ELISABETH
Other - Last Name:LEMKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1215 E ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5762
Mailing Address - Country:US
Mailing Address - Phone:863-802-3800
Mailing Address - Fax:863-802-0480
Practice Address - Street 1:1215 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5762
Practice Address - Country:US
Practice Address - Phone:863-802-3800
Practice Address - Fax:863-802-0480
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 248602251P0200X
NCP12209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY905LOtherBLUE CROSS BLUE SHIELD
FL1407834021OtherGROUP NPI
FL592984541OtherGROUP TAX ID