Provider Demographics
NPI:1205273026
Name:DIMAIO, ANTHONY JOSEPH JR (DPT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:DIMAIO
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 AUDUBON OAKS CIR BLDG 12
Mailing Address - Street 2:APARTMENT # 305
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-5941
Mailing Address - Country:US
Mailing Address - Phone:301-876-1988
Mailing Address - Fax:
Practice Address - Street 1:11754 MARTIN LUTHER KING BLVD E
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4923
Practice Address - Country:US
Practice Address - Phone:813-661-8267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV003152225100000X
FL28312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist