Provider Demographics
NPI:1336325885
Name:GALIATSATOS, TINA MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:GALIATSATOS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:GALIATSATOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:15 WIGHTMAN RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-3757
Mailing Address - Country:US
Mailing Address - Phone:978-658-7742
Mailing Address - Fax:
Practice Address - Street 1:15 WIGHTMAN RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-3757
Practice Address - Country:US
Practice Address - Phone:978-658-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3488225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant