Provider Demographics
NPI:1780881060
Name:MOURELATOS, MARIA (PTA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MOURELATOS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PEPPER CIR W
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3515
Mailing Address - Country:US
Mailing Address - Phone:516-795-7303
Mailing Address - Fax:
Practice Address - Street 1:5 PEPPER CIR W
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3515
Practice Address - Country:US
Practice Address - Phone:631-645-8329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032979-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist