Provider Demographics
NPI:1568854081
Name:SARANTAPOULAS, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SARANTAPOULAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:294 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-2610
Practice Address - Country:US
Practice Address - Phone:845-729-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001505225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant