Provider Demographics
NPI:1851052138
Name:ANTLEY, CRAIG (LMT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:ANTLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 SW 10TH TER APT 20
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-7874
Mailing Address - Country:US
Mailing Address - Phone:843-901-9177
Mailing Address - Fax:
Practice Address - Street 1:1810 NW 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-8535
Practice Address - Country:US
Practice Address - Phone:843-901-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98683225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist