Provider Demographics
NPI:1306030622
Name:DANIEL M. ANTONINO PROF. CORP.
Entity type:Organization
Organization Name:DANIEL M. ANTONINO PROF. CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO, SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:ANTONINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:702-233-3288
Mailing Address - Street 1:7955 W SAHARA AVE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7910
Mailing Address - Country:US
Mailing Address - Phone:702-233-3288
Mailing Address - Fax:702-233-2369
Practice Address - Street 1:7955 W SAHARA AVE
Practice Address - Street 2:SUITE #103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7910
Practice Address - Country:US
Practice Address - Phone:702-233-3288
Practice Address - Fax:702-233-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP54337Medicare UPIN
NVV36194Medicare PIN