Provider Demographics
NPI:1629243969
Name:XINTAROPOULOS, DEMETRE (PTA)
Entity Type:Individual
Prefix:MR
First Name:DEMETRE
Middle Name:
Last Name:XINTAROPOULOS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W CUMMINGS PARK STE 1400
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-7232
Mailing Address - Country:US
Mailing Address - Phone:781-938-1223
Mailing Address - Fax:781-938-1226
Practice Address - Street 1:400 W CUMMINGS PARK
Practice Address - Street 2:1400
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6519
Practice Address - Country:US
Practice Address - Phone:781-938-1223
Practice Address - Fax:781-938-1226
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3468225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant