Provider Demographics
NPI:1942448378
Name:COLLAZO, ANTONIO (LMT)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:COLLAZO
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 1:7827 N. ARMENIA AVE.
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-7308
Mailing Address - Country:US
Mailing Address - Phone:813-562-6583
Mailing Address - Fax:
Practice Address - Street 1:7827 N ARMENIA AVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-3849
Practice Address - Country:US
Practice Address - Phone:813-562-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40061225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist