Provider Demographics
NPI:1710919022
Name:ANTONACCI, CHRISTOPHER JOSEPH (PT, ATC,CSCS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:ANTONACCI
Suffix:
Gender:M
Credentials:PT, ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ALLISON RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7115
Mailing Address - Country:US
Mailing Address - Phone:203-249-5366
Mailing Address - Fax:
Practice Address - Street 1:650 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-4020
Practice Address - Country:US
Practice Address - Phone:203-852-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT007001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650001161Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CTP41705Medicare UPIN