Individual provider Active NPI

Jonalyn Antonio

  • Physical Therapy Assistant
  • Port Jefferson Station, NY
National Provider Identifier
1235083064
Registry record updated Feb 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
011154 Issued in NY
Practice address
587 Jayne Blvd
Port Jefferson Station, NY 11776-2946
Phone
(619) 522-4007
NPI assigned
Feb 26, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 225200000X 011154 NY Primary

Addresses

Primary practice location

587 Jayne Blvd
Port Jefferson Station, NY 11776-2946

Mailing address

587 Jayne Blvd
Port Jefferson Station, NY 11776-2946
Phone (619) 522-4007

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
011154NYMDOptometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1772064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772064000000",
    "number": "1235083064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "587 JAYNE BLVD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762946",
            "telephone_number": "619-522-4007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "587 JAYNE BLVD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762946",
            "telephone_number": "619-522-4007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONIO",
        "first_name": "JONALYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-02-26",
        "last_updated": "2026-02-26",
        "certification_date": "2026-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "011154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.