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General NPI Number Information
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NPI Number | 1306057146
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Entity Type | Individual
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Provider Name | JIMMY KAKOURIS PT, DPT. CSCS
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 81 SHREWSBURY ST STE 1
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City | BOYLSTON
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State | MA
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Zip | 01505-1701
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Country | US
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Telephone | 774-614-1322
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Fax | 774-614-1171
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Provider Business Mailing Address
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Address Line | 84 BARRY RD
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City | WORCESTER
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State | MA
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Zip | 01609-1136
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Country | US
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Telephone | 239-209-0320
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Fax | 239-209-0320
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 18231
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License Number State | MA
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