Individual
MS. NORMA R ANTEDOMENICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
275 APPLECROSS LN, POTTSBORO, TX 75076-3809
(940) 300-5953
Mailing address
275 APPLECROSS LN, POTTSBORO, TX 75076-3809
(940) 300-5953
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1122265
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
456619
MEDICARE PTAN
TX
01
—
8T4408
BLUE CROSS PROVIDER NUMBE
TX
Enumeration date
08/10/2006
Last updated
12/17/2014
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