Provider Demographics
NPI:1356075188
Name:ANASTOS, IOANNIS DIMITRIOS (DPT)
Entity Type:Individual
Prefix:DR
First Name:IOANNIS
Middle Name:DIMITRIOS
Last Name:ANASTOS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4764
Mailing Address - Country:US
Mailing Address - Phone:708-612-3339
Mailing Address - Fax:
Practice Address - Street 1:713 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4764
Practice Address - Country:US
Practice Address - Phone:708-612-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist