Provider Demographics
NPI:1558599910
Name:GUDINO, ANTONIO JR (ATC/LAT)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:GUDINO
Suffix:JR
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19919 WALLINGFORD AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3728
Mailing Address - Country:US
Mailing Address - Phone:505-319-6378
Mailing Address - Fax:
Practice Address - Street 1:19919 WALLINGFORD AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3728
Practice Address - Country:US
Practice Address - Phone:505-319-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600370182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer