Provider Demographics
NPI:1023044872
Name:KOULIZAKIS, EUGENIA E (PT)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:E
Last Name:KOULIZAKIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118
Mailing Address - Country:US
Mailing Address - Phone:540-687-8181
Mailing Address - Fax:540-687-8256
Practice Address - Street 1:133 MAPLE AVE E
Practice Address - Street 2:SUITE 309
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:703-281-0288
Practice Address - Fax:703-281-7089
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012930225100000X
VA2305203703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist