Provider Demographics
NPI:1629459490
Name:MUNOZ-BERISTAIN, ANTONIO (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:MUNOZ-BERISTAIN
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 LAVANHAM CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3069
Mailing Address - Country:US
Mailing Address - Phone:407-865-1149
Mailing Address - Fax:
Practice Address - Street 1:1224 LAVANHAM CT
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-3069
Practice Address - Country:US
Practice Address - Phone:407-865-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 41862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer