Active NPI
Juan Dominic Antolin
- Physical Therapist
- Sunrise, FL
National Provider Identifier
1922550763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4707
- Practice address
- 1580 Sawgrass Corporate Pkwy
Suite 200
Sunrise, FL 33323-2859 - Phone
- (800) 886-1808
- NPI assigned
- Oct 27, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4707 | NM | Primary |
| Physical Therapist | 225100000X | 0013422 | CO | |
| Physical Therapist | 225100000X | 5501017461 | MI |
Addresses
Primary practice location
1580 Sawgrass Corporate Pkwy
Suite 200
Sunrise, FL 33323-2859
Mailing address
1580 Sawgrass Corporate Pkwy
Suite 200
Sunrise, FL 33323-2859
Phone (800) 886-1808
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4707 | NM | MD | Addiction (Substance Use Disorder) Counselor |
| 0013422 | CO | MD | Physical Therapist |
| 5501017461 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477526400000",
"number": "1922550763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1580 SAWGRASS CORPORATE PKWY",
"address_2": "SUITE 200",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333232859",
"telephone_number": "800-886-1808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1580 SAWGRASS CORPORATE PKWY",
"address_2": "SUITE 200",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333232859",
"telephone_number": "800-886-1808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTOLIN",
"first_name": "JUAN DOMINIC",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-10-27",
"last_updated": "2016-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "4707",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "0013422",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501017461",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sunrise, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.