Individual
NIKKO TAN ANTIDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
6812 SW 81ST ST, MIAMI, FL 33143-7708
(305) 905-4188
Mailing address
1700 NE 105TH ST APT 306, MIAMI SHORES, FL 33138-2140
(305) 815-1168
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
32769
FL
Other
Enumeration date
06/08/2023
Last updated
06/08/2023
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