Healthcare Provider Details

I. General information

NPI: 1093206443
Provider Name (Legal Business Name): KELSIE A. GIANNOULIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 10/21/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3215 BOX RAMSTEIN
APO AE
09094-3215
US

IV. Provider business mailing address

86 MDG UNIT 3215, RAMSTEIN AB
APO AE
09094
US

V. Phone/Fax

Practice location:
  • Phone: 314-480-1559
  • Fax:
Mailing address:
  • Phone: 314-480-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211965
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP18777
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: