Provider Demographics
NPI:1942221767
Name:CANTRELL, ANASTASIA ANDRIS
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:ANDRIS
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 OSIGIAN BLVD
Mailing Address - Street 2:THE CANTRELL CENTER FOR PHYSICAL THERAPY & SPORTS MED
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:478-953-3535
Mailing Address - Fax:478-953-0353
Practice Address - Street 1:405 OSIGIAN BLVD
Practice Address - Street 2:THE CANTRELL CENTER FOR PHYSICAL THERAPY & SPORTS MED
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-953-3535
Practice Address - Fax:478-953-0353
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5Z060799OtherBCBS
GA65PCBHPMedicare ID - Type Unspecified