Provider Demographics
NPI:1023255627
Name:ANTE, SHERYL GONZALES (RPT)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:GONZALES
Last Name:ANTE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 S MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4761
Mailing Address - Country:US
Mailing Address - Phone:714-658-6321
Mailing Address - Fax:
Practice Address - Street 1:761 S MELROSE ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4761
Practice Address - Country:US
Practice Address - Phone:714-658-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist