Provider Demographics
NPI:1518930510
Name:MUNIZ, ANTONELLA GIOVANNA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANTONELLA
Middle Name:GIOVANNA
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANTONELLA
Other - Middle Name:G
Other - Last Name:MICALIZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 HARLOW STREET
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MA
Mailing Address - Zip Code:01929
Mailing Address - Country:US
Mailing Address - Phone:978-526-9400
Mailing Address - Fax:978-526-9299
Practice Address - Street 1:8 ATWATER AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944
Practice Address - Country:US
Practice Address - Phone:978-526-9400
Practice Address - Fax:978-526-9299
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y68492OtherBCBS
Y68492OtherBCBS