Provider Demographics
NPI:1053696799
Name:FOX, ANTONIO JI (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:JI
Last Name:FOX
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12 ANASTASIA DR SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1461
Mailing Address - Country:US
Mailing Address - Phone:770-870-8222
Mailing Address - Fax:
Practice Address - Street 1:1995 N PARK PL SE STE 519
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7801
Practice Address - Country:US
Practice Address - Phone:770-989-1405
Practice Address - Fax:770-907-5746
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist