Provider Demographics
NPI:1639139082
Name:KATSAROS, POLIXENI (PT DPT)
Entity Type:Individual
Prefix:MS
First Name:POLIXENI
Middle Name:
Last Name:KATSAROS
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DANVILLE MT RD
Mailing Address - Street 2:
Mailing Address - City:GREAT MEADOWS
Mailing Address - State:NJ
Mailing Address - Zip Code:07838
Mailing Address - Country:US
Mailing Address - Phone:908-637-8173
Mailing Address - Fax:
Practice Address - Street 1:33 DANVILLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:GREAT MEADOWS
Practice Address - State:NJ
Practice Address - Zip Code:07838-2106
Practice Address - Country:US
Practice Address - Phone:973-670-6206
Practice Address - Fax:908-637-8173
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA 00412400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
31667Medicare ID - Type Unspecified