Provider Demographics
NPI:1194944561
Name:COSMIOS, DIMITRI (PT)
Entity type:Individual
Prefix:MR
First Name:DIMITRI
Middle Name:
Last Name:COSMIOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4959 N STATE ROAD 7
Mailing Address - Street 2:STE D
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5871
Mailing Address - Country:US
Mailing Address - Phone:954-717-1983
Mailing Address - Fax:954-717-1984
Practice Address - Street 1:4959 N STATE ROAD 7
Practice Address - Street 2:STE D
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-5871
Practice Address - Country:US
Practice Address - Phone:954-717-1983
Practice Address - Fax:954-717-1984
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 19201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist