Provider Demographics
NPI:1881819373
Name:SAMARISTA, ANTONIO MONTALES JR
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:MONTALES
Last Name:SAMARISTA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 SW 84TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5131
Mailing Address - Country:US
Mailing Address - Phone:954-435-1147
Mailing Address - Fax:
Practice Address - Street 1:2231 SW 84TH TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5131
Practice Address - Country:US
Practice Address - Phone:954-435-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist