Provider Demographics
NPI:1871934174
Name:PICONE, ANTOINETTE (CMT)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:PICONE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352004
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80035-2004
Mailing Address - Country:US
Mailing Address - Phone:303-960-9270
Mailing Address - Fax:
Practice Address - Street 1:11160 HURON ST
Practice Address - Street 2:35
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4377
Practice Address - Country:US
Practice Address - Phone:303-960-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008865225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist