Provider Demographics
NPI:1639986979
Name:CROCITTO, ANITA M (LMT, BA)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:M
Last Name:CROCITTO
Suffix:
Gender:F
Credentials:LMT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18482 TAPESTRY LAKE CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4630
Mailing Address - Country:US
Mailing Address - Phone:813-391-7070
Mailing Address - Fax:
Practice Address - Street 1:18482 TAPESTRY LAKE CIR APT 102
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4630
Practice Address - Country:US
Practice Address - Phone:813-391-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA32002172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist