Provider Demographics
NPI:1487853354
Name:VARELA, ANTONIO JOAQUIN (DPT MHSC MTC)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:JOAQUIN
Last Name:VARELA
Suffix:
Gender:M
Credentials:DPT MHSC MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 MOSES CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-616-1282
Mailing Address - Fax:
Practice Address - Street 1:5210 CORPORATE CENTER CT SE
Practice Address - Street 2:SUITE D
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5952
Practice Address - Country:US
Practice Address - Phone:360-455-8155
Practice Address - Fax:360-455-1655
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60017380225100000X
FL180582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA236094OtherL&I
WA2767VAOtherREGENCE
WA8525339OtherDSHS
WA3456VAOtherREGENCE
WAG8873416OtherMEDICARE
WA8947463OtherL&I CRIME
WA2769VAOtherREGENCE
WA2766VAOtherREGENCE
WA6788VAOtherREGENCE