Maria Antonetti, LPTA13089

Individual provider Active NPI Physical Therapy Assistant · Crystal River, FL

NPI 1003050600 · NPPES record last updated Nov 15, 2019

Key facts

NPI
1003050600
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
PTA13089 (FL)
Practice address
394 N Suncoast Blvd Ste 40
Crystal River, FL 34429-5466
Phone
(352) 795-6225
Fax
(352) 795-6065
NPI assigned
Apr 27, 2009
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
PTA13089FLMDPhysical Therapy Assistant

Practice roles (1 of 3)

OrganizationSpecialtyStatusNew patients
TLC Rehab, LLC Past Accepting new patients

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA13089 FL Yes

Addresses

Primary practice location

394 N Suncoast Blvd Ste 40
Crystal River, FL 34429-5466

Mailing address

11242 Scenic Vista Dr
Clermont, FL 34711-8669
Phone (352) 247-5737

Other identifiers

IdentifierTypeStateIssuer
106898OtherFLMEDICARE ID

Other names

  • Mrs. Maria Antonetti Other name

Other providers in Crystal River, FL

All providers in Crystal River, FL · Physical Therapy Assistant in Florida

Sources for this page

Verify at the official NPI Registry.