Provider Demographics
NPI:1952468696
Name:EICHOLZER, ANTOINETTE M (PT)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:M
Last Name:EICHOLZER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 S BAY RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8652
Mailing Address - Country:US
Mailing Address - Phone:315-458-5442
Mailing Address - Fax:315-458-5490
Practice Address - Street 1:5740 S BAY RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8652
Practice Address - Country:US
Practice Address - Phone:315-458-5442
Practice Address - Fax:315-458-5490
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0216381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0216381OtherLICENSE