Provider Demographics
NPI:1265936181
Name:ANASTOPOULOS, JOHN TYLER (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TYLER
Last Name:ANASTOPOULOS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 JAMES CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8694
Mailing Address - Country:US
Mailing Address - Phone:336-202-2436
Mailing Address - Fax:
Practice Address - Street 1:104A HUFFMAN MILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5113
Practice Address - Country:US
Practice Address - Phone:336-270-3611
Practice Address - Fax:336-270-4467
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist