Provider Demographics
NPI:1689851214
Name:DIOMETRE, ANTONI (MT)
Entity Type:Individual
Prefix:
First Name:ANTONI
Middle Name:
Last Name:DIOMETRE
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 US HIGHWAY 19 STE 145
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-3999
Mailing Address - Country:US
Mailing Address - Phone:727-938-2216
Mailing Address - Fax:727-491-3998
Practice Address - Street 1:2435 US HIGHWAY 19 STE 145
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3999
Practice Address - Country:US
Practice Address - Phone:727-938-2216
Practice Address - Fax:727-491-3998
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA15871172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H1036-118OtherHUMANA HMO MEDICARE