Provider Demographics
NPI:1679665707
Name:MUNOZ, ANTOINETTE (PT)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
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:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-0776
Mailing Address - Country:US
Mailing Address - Phone:928-639-0166
Mailing Address - Fax:928-639-0167
Practice Address - Street 1:1835 W HIGHWAY 89A
Practice Address - Street 2:SUITE 6
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5570
Practice Address - Country:US
Practice Address - Phone:928-282-2411
Practice Address - Fax:928-282-2067
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ428179Medicaid
Z119799Medicare PIN
P29282Medicare UPIN