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NPI Code Detail

MEDICARE: KRYSTINA MANTZOURANIS

MEDICARE: KRYSTINA MANTZOURANIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
22355S0801XSpeech-Language Assistant
3235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1003274481
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTINA MANTZOURANIS
Provider Business Mailing Address
First Line : 1575 NANTAHALA BLVD
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-9753
Country : US
Telephone Number : 757-642-1452
Fax Number :
Provider Business Practice Location Address
First Line : 2685 LEEDS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-6861
Country : US
Telephone Number : 843-529-3130
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2016
Last Update Date : 08/11/2019

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Directions to “ KRYSTINA MANTZOURANIS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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