Provider Demographics
NPI:1033408349
Name:KATSOULIS, PANAGOULA (LMT)
Entity Type:Individual
Prefix:MS
First Name:PANAGOULA
Middle Name:
Last Name:KATSOULIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:ULA
Other - Middle Name:
Other - Last Name:KATSOULIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1519 N PALETHORP ST
Mailing Address - Street 2:REAR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-3814
Mailing Address - Country:US
Mailing Address - Phone:646-645-5207
Mailing Address - Fax:
Practice Address - Street 1:231 W 21ST ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3116
Practice Address - Country:US
Practice Address - Phone:646-645-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist