Individual
MRS. SUSAN S ANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
15800 NE 148TH TERRACE RD, FORT MC COY, FL 32134-8071
(352) 812-0109
Mailing address
15800 NE 148TH TERRACE RD, FORT MC COY, FL 32134-8071
(352) 812-0109
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA47748
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C2621
BLUE CROSS/ BLUE SHIELD
FL
Enumeration date
08/23/2007
Last updated
08/23/2007
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