Healthcare Provider Details

I. General information

NPI: 1154076842
Provider Name (Legal Business Name): CHRISTOS TZOGKANOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 H ST NW STE 1101-1
WASHINGTON DC
20005-4706
US

IV. Provider business mailing address

1331 H ST NW STE 1101-1
WASHINGTON DC
20005-4706
US

V. Phone/Fax

Practice location:
  • Phone: 571-294-2345
  • Fax:
Mailing address:
  • Phone: 571-294-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT2516
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: