Provider Demographics
NPI:1770774473
Name:ANTOSH, FRANKLIN A (MPT)
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:A
Last Name:ANTOSH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 ROUTE 113 STE B
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1022
Mailing Address - Country:US
Mailing Address - Phone:215-721-1024
Mailing Address - Fax:215-721-2081
Practice Address - Street 1:718 ROUTE 113 STE B
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1022
Practice Address - Country:US
Practice Address - Phone:215-721-1024
Practice Address - Fax:215-721-2081
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001977279OtherHIGHMARK BLUE SHIELD
PA50071451OtherCAPITAL BLUE CROSS
PA7205900OtherAETNA
PA50071451OtherCAPITAL BLUE CROSS