Provider Demographics
NPI:1104966118
Name:ANTONY, PATRICE S (PT, GCS)
Entity type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:S
Last Name:ANTONY
Suffix:
Gender:F
Credentials:PT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 SIDCUP RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3523
Mailing Address - Country:US
Mailing Address - Phone:407-951-5266
Mailing Address - Fax:407-898-9098
Practice Address - Street 1:1219 SIDCUP RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-3523
Practice Address - Country:US
Practice Address - Phone:407-951-5266
Practice Address - Fax:407-898-9098
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist