Provider Demographics
NPI:1558787754
Name:PIEMONTESE, ANTHONY ANDREW JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ANDREW
Last Name:PIEMONTESE
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:20237 SILKTASSEL RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-3025
Mailing Address - Country:US
Mailing Address - Phone:772-475-3721
Mailing Address - Fax:
Practice Address - Street 1:294 25TH ST SE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-8232
Practice Address - Country:US
Practice Address - Phone:772-475-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT10217225200000X
FLPTA22843225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant