Provider Demographics
NPI:1326499435
Name:ANASTASIOU, MICHAEL (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ANASTASIOU
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5711
Mailing Address - Country:US
Mailing Address - Phone:732-491-9299
Mailing Address - Fax:
Practice Address - Street 1:3800 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5711
Practice Address - Country:US
Practice Address - Phone:732-491-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2018-11-28
Deactivation Date:2018-11-19
Deactivation Code:
Reactivation Date:2018-11-28
Provider Licenses
StateLicense IDTaxonomies
PATEI003989225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant