Provider Demographics
NPI:1609393412
Name:STAVROS, MARIA PANAGIOTA (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:PANAGIOTA
Last Name:STAVROS
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BELLEVUE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2120
Mailing Address - Country:US
Mailing Address - Phone:617-785-0143
Mailing Address - Fax:
Practice Address - Street 1:607 BOYLSTON ST FL 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3604
Practice Address - Country:US
Practice Address - Phone:857-350-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist