Provider Demographics
NPI:1164186326
Name:CATALYST PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:CATALYST PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIMITRIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTOPOULOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-707-6970
Mailing Address - Street 1:69 HUNT DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1149
Mailing Address - Country:US
Mailing Address - Phone:718-707-6970
Mailing Address - Fax:929-208-0767
Practice Address - Street 1:1206 COURT STREET
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5802
Practice Address - Country:US
Practice Address - Phone:718-707-6970
Practice Address - Fax:929-208-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Multi-Specialty