Provider Demographics
NPI:1104251156
Name:SALTAS, ANDREAS (PT, PTA)
Entity type:Individual
Prefix:
First Name:ANDREAS
Middle Name:
Last Name:SALTAS
Suffix:
Gender:M
Credentials:PT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20103 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1021
Mailing Address - Country:US
Mailing Address - Phone:347-807-7661
Mailing Address - Fax:
Practice Address - Street 1:19413 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3032
Practice Address - Country:US
Practice Address - Phone:716-428-3500
Practice Address - Fax:718-428-0800
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62036550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist