Provider Demographics
NPI:1427238427
Name:ANASTASIO, PATRICIA J II
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:J
Last Name:ANASTASIO
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 HUNTERS RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-6654
Mailing Address - Country:US
Mailing Address - Phone:863-670-0335
Mailing Address - Fax:863-858-1516
Practice Address - Street 1:1203 MAYFLOWER DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-3621
Practice Address - Country:US
Practice Address - Phone:863-670-0335
Practice Address - Fax:863-858-1516
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40371225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist