Provider Demographics
NPI:1114057767
Name:SARATSOPOULOU, AGLAIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:AGLAIA
Middle Name:
Last Name:SARATSOPOULOU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:KATSAMBOULAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:33 BROOK TRAIL ROAD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-318-6957
Mailing Address - Fax:617-323-8014
Practice Address - Street 1:41 POPLAR STREET
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:617-323-8013
Practice Address - Fax:617-232-8014
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67470OtherBCBS
MA0309141Medicaid
MA0309141Medicaid