Provider Demographics
NPI:1871697144
Name:TSOLIS, FOTIS (BS PT)
Entity type:Individual
Prefix:MR
First Name:FOTIS
Middle Name:
Last Name:TSOLIS
Suffix:
Gender:M
Credentials:BS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 15 NORTHERN BLVD
Mailing Address - Street 2:SUITE LLC
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361
Mailing Address - Country:US
Mailing Address - Phone:718-225-7500
Mailing Address - Fax:718-225-7555
Practice Address - Street 1:222 15 NORTHERN BLVD
Practice Address - Street 2:SUITE LLC
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361
Practice Address - Country:US
Practice Address - Phone:718-225-7500
Practice Address - Fax:718-225-7555
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
05566Medicare ID - Type Unspecified