Provider Demographics
NPI:1023724770
Name:ANTONIO, ANA SAMANTHA (PT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:SAMANTHA
Last Name:ANTONIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1101
Mailing Address - Country:US
Mailing Address - Phone:718-661-1710
Mailing Address - Fax:718-886-6414
Practice Address - Street 1:4343 KISSENA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2914
Practice Address - Country:US
Practice Address - Phone:718-661-1770
Practice Address - Fax:718-886-6414
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist