Provider Demographics
NPI:1578727277
Name:HANDAL, ANTHONY JOHN
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:HANDAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:A.J.
Other - Middle Name:
Other - Last Name:HANDAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:1014 PORTMOOR WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4617
Mailing Address - Country:US
Mailing Address - Phone:407-905-9290
Mailing Address - Fax:
Practice Address - Street 1:1014 PORTMOOR WAY
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4617
Practice Address - Country:US
Practice Address - Phone:407-905-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811684900Medicaid