Provider Demographics
NPI:1386768182
Name:FRANKS, ANTONINA (PT)
Entity type:Individual
Prefix:
First Name:ANTONINA
Middle Name:
Last Name:FRANKS
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 1:507 W CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4449
Mailing Address - Country:US
Mailing Address - Phone:843-662-1234
Mailing Address - Fax:843-669-7144
Practice Address - Street 1:507 W CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4449
Practice Address - Country:US
Practice Address - Phone:843-662-1234
Practice Address - Fax:843-669-7144
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386768182OtherTRICARE CHAMPUS
DE1386768182Medicaid
50700031OtherCARE FIRST
91125801OtherCARE FIRST
PA1988262OtherPABS
2858132000OtherIBC AMERIHEALTH
11779853OtherCAQH
DE1386768182Medicaid
91125801OtherCARE FIRST