Provider Demographics
NPI:1639365125
Name:ANTONI, JOHN RICHARD (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:ANTONI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 S WHITE MOUNTAIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7876
Mailing Address - Country:US
Mailing Address - Phone:928-537-8766
Mailing Address - Fax:928-537-8786
Practice Address - Street 1:4800 S WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7876
Practice Address - Country:US
Practice Address - Phone:928-537-8766
Practice Address - Fax:928-537-8786
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ134221OtherNEAZ
AZ19-099814OtherSTATE COMPENSATION FUND
AZ134221OtherAHCCS
AZ6400OtherHUMANA
AZAZ0298660OtherBLUE CROSS/ BLUE SHIELD
AZDA4951OtherRAILROAD MEDICARE
AZ134221OtherAPIPA
AZZ64001Medicare PIN