Provider Demographics
NPI:1710369145
Name:SCIULLI, ANTONIO (PT)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:SCIULLI
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 1:890 W LOVELAND AVE APT A11
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-2231
Mailing Address - Country:US
Mailing Address - Phone:310-985-6243
Mailing Address - Fax:
Practice Address - Street 1:890 W LOVELAND AVE APT A11
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-2231
Practice Address - Country:US
Practice Address - Phone:310-985-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28378225100000X
PA009608L225100000X
CA23859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist