Provider Demographics
NPI:1538467147
Name:ANTOLICK, BRIDGETT MURIEL (LMT)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETT
Middle Name:MURIEL
Last Name:ANTOLICK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 OLD WHITE WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4353
Mailing Address - Country:US
Mailing Address - Phone:407-461-5504
Mailing Address - Fax:
Practice Address - Street 1:933 OLD WHITE WAY
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4353
Practice Address - Country:US
Practice Address - Phone:407-461-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist