Provider Demographics
NPI:1811229586
Name:DEMETRIADES, MICHAEL M (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:DEMETRIADES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 BRADLEY RD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2296
Mailing Address - Country:US
Mailing Address - Phone:203-389-4593
Mailing Address - Fax:203-389-4609
Practice Address - Street 1:1 BRADLEY RD
Practice Address - Street 2:SUITE 801
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2296
Practice Address - Country:US
Practice Address - Phone:203-389-4593
Practice Address - Fax:203-389-4609
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2012-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT008732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist