Provider Demographics
NPI:1861645533
Name:GARROVILLAS, ANTONETTE NERY (PT)
Entity Type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:NERY
Last Name:GARROVILLAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANTONETTE
Other - Middle Name:BOLUS
Other - Last Name:NERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:27 SCENIC DR APT C
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-1823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 SCENIC DRIVE
Practice Address - Street 2:APT C
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520
Practice Address - Country:US
Practice Address - Phone:646-541-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025372-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics