Provider Demographics
NPI:1366541245
Name:ANTONELLI'S REHABSOUTH
Entity type:Organization
Organization Name:ANTONELLI'S REHABSOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:256-546-6553
Mailing Address - Street 1:623 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4136
Mailing Address - Country:US
Mailing Address - Phone:256-546-6553
Mailing Address - Fax:256-546-5720
Practice Address - Street 1:623 WALNUT ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4136
Practice Address - Country:US
Practice Address - Phone:256-546-6553
Practice Address - Fax:256-546-5720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTONELLI'S REHABSOUTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP24326Medicare UPIN