Provider Demographics
NPI:1538288543
Name:ANTOLIN, MACARMENLEAH SABADO
Entity Type:Individual
Prefix:
First Name:MACARMENLEAH
Middle Name:SABADO
Last Name:ANTOLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2698 KIMBERLY FOREST DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-9575
Mailing Address - Country:US
Mailing Address - Phone:904-928-9850
Mailing Address - Fax:
Practice Address - Street 1:2802 PARENTAL HOME RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5702
Practice Address - Country:US
Practice Address - Phone:904-721-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist