Provider Demographics
NPI:1063975399
Name:ROTSIDES, DEMETRIOS (DPT)
Entity type:Individual
Prefix:
First Name:DEMETRIOS
Middle Name:
Last Name:ROTSIDES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WESTERN AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-9364
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:195 RT 46, SUITE 101
Practice Address - Street 2:UNIT B
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803
Practice Address - Country:US
Practice Address - Phone:973-598-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01848400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist