Provider Demographics
NPI:1932496973
Name:FLYNN, ANTONIA CAROLINE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ANTONIA
Middle Name:CAROLINE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:ANTONIA
Other - Middle Name:CAROLINE
Other - Last Name:HAGGARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5677 OBERLIN DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1740
Mailing Address - Country:US
Mailing Address - Phone:858-457-8419
Mailing Address - Fax:858-457-0670
Practice Address - Street 1:5677 OBERLIN DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1740
Practice Address - Country:US
Practice Address - Phone:858-457-8419
Practice Address - Fax:858-457-0670
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist