Individual
KYLE ANTONIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
585 SATURN BLVD STE A, SAN DIEGO, CA 92154-4721
(619) 591-1190
Mailing address
6895 RAMFOS CIR, SAN DIEGO, CA 92139-3216
(619) 578-1483
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
51482
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F2125959
DRIVER'S LICENSE
CA
Enumeration date
08/15/2022
Last updated
08/15/2022
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