Provider Demographics
NPI:1134277841
Name:SECCHIARI, ANTHONY J JR (RPT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:SECCHIARI
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 ATHENS AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-1515
Mailing Address - Country:US
Mailing Address - Phone:850-457-0101
Mailing Address - Fax:850-457-0104
Practice Address - Street 1:1949 ATHENS AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-1515
Practice Address - Country:US
Practice Address - Phone:850-457-0101
Practice Address - Fax:850-457-0104
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7362Medicare UPIN
FLU7362Medicare ID - Type Unspecified