Healthcare Provider Details

I. General information

NPI: 1164186326
Provider Name (Legal Business Name): CATALYST PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 COURT STREET
CLEARWATER FL
33756-5802
US

IV. Provider business mailing address

69 HUNT DR
JERICHO NY
11753-1149
US

V. Phone/Fax

Practice location:
  • Phone: 718-707-6970
  • Fax: 929-208-0767
Mailing address:
  • Phone: 718-707-6970
  • Fax: 929-208-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DIMITRIUS KOSTOPOULOUS
Title or Position: OWNER
Credential:
Phone: 718-707-6970