Provider Demographics
NPI:1255621264
Name:KLOTSOS, ANASTASIA (PT)
Entity type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:
Last Name:KLOTSOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:STRATIDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:334 NASSAU BLVD.
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-214-6013
Mailing Address - Fax:516-214-6013
Practice Address - Street 1:23-19 BELL BLVD.
Practice Address - Street 2:SUITE 203
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360
Practice Address - Country:US
Practice Address - Phone:718-428-2600
Practice Address - Fax:718-428-7429
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist