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General NPI Number Information
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NPI Number | 1033408349
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Entity Type | Individual
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Provider Name | PANAGOULA KATSOULIS LMT
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Gender | Female
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 231 W 21ST ST LOWER LEVEL
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City | NEW YORK
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State | NY
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Zip | 10011-3116
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Country | US
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Telephone | 646-645-5207
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Fax |
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Provider Business Mailing Address
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Address Line | 1519 N PALETHORP ST REAR
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3814
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Country | US
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Telephone | 646-645-5207
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 01
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License Number State | NY
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