Healthcare Provider Details

I. General information

NPI: 1407842297
Provider Name (Legal Business Name): HARRY JOHN LEKOSIOTIS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 W CENTRE AVE
PORTAGE MI
49024-4634
US

IV. Provider business mailing address

3930 W CENTRE AVE
PORTAGE MI
49024-4634
US

V. Phone/Fax

Practice location:
  • Phone: 269-324-4333
  • Fax: 269-324-4343
Mailing address:
  • Phone: 269-324-4333
  • Fax: 269-324-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501004512
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: