Provider Demographics
NPI:1669682712
Name:ANTONE, GARY T (MPT, ATC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:T
Last Name:ANTONE
Suffix:
Gender:M
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 N. FRESNO ST.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-7406
Mailing Address - Country:US
Mailing Address - Phone:559-579-1410
Mailing Address - Fax:
Practice Address - Street 1:7614 N. FRESNO ST.
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-7406
Practice Address - Country:US
Practice Address - Phone:559-579-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27651225100000X
CA0600020752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer