Provider Demographics
NPI:1710019583
Name:ANTONY, EMILY JUNE (ATC, MED)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JUNE
Last Name:ANTONY
Suffix:
Gender:F
Credentials:ATC, MED
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3545 BLUE JAY WAY
Mailing Address - Street 2:200
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2254
Mailing Address - Country:US
Mailing Address - Phone:651-365-7637
Mailing Address - Fax:
Practice Address - Street 1:775 PRAIRIE CENTER DR
Practice Address - Street 2:250
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7314
Practice Address - Country:US
Practice Address - Phone:952-944-5314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer