Provider Demographics
NPI:1497781157
Name:SPIRATOS, MARKELLA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARKELLA
Middle Name:
Last Name:SPIRATOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2643
Mailing Address - Country:US
Mailing Address - Phone:718-707-6970
Mailing Address - Fax:718-652-6977
Practice Address - Street 1:208 01 NORTHERN BLVD 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3040
Practice Address - Country:US
Practice Address - Phone:718-224-2867
Practice Address - Fax:718-224-3782
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013822-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06322IMedicare PIN