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General NPI Number Information
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NPI Number | 1548900418
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Entity Type | Organization
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Legal Business Name | ETHOS REHABILITATION INC
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Dates
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Enumeration Date | 03/30/2022
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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 |
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Provider Business Mailing Address
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Address Line | PO BOX 1110
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City | BOYLSTON
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State | MA
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Zip | 01505-1810
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Country | US
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Telephone | 774-614-1322
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | JIMMY KAKOURIS
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Credential | PT, DPT, CSCS
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Telephone | 774-614-1322
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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