Provider Demographics
NPI:1912129321
Name:BAKAS, DEMETRA (LPT)
Entity Type:Individual
Prefix:MS
First Name:DEMETRA
Middle Name:
Last Name:BAKAS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DUNNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2575
Mailing Address - Country:US
Mailing Address - Phone:336-288-6354
Mailing Address - Fax:
Practice Address - Street 1:7 DUNNBERRY CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2575
Practice Address - Country:US
Practice Address - Phone:336-288-6354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3795OtherPHYSICAL THERAPIST LICENS