Provider Demographics
NPI:1750115192
Name:MESIMERIS, DEMETRIOS VASILIOS (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:DEMETRIOS
Middle Name:VASILIOS
Last Name:MESIMERIS
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1435
Mailing Address - Country:US
Mailing Address - Phone:631-626-6578
Mailing Address - Fax:
Practice Address - Street 1:1242 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1435
Practice Address - Country:US
Practice Address - Phone:631-626-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0530602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic