Basic Information
| Provider Information | |||||||||
| NPI: | 1013265057 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWARD | ||||||||
| FirstName: | ANTONIO | ||||||||
| MiddleName: | TOM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19305 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282199305 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5735 PROSPERITY CROSSING DR | ||||||||
| Address2: | STE 2100 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282691360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048634878 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2012 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081S0010X | 2021-03414 | NC | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 208100000X | 2021-03414 | NC | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.