Provider Demographics
NPI:1093206443
Name:GIANNOULIS, KELSIE A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:A
Last Name:GIANNOULIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 PINEHURST AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7138
Mailing Address - Country:US
Mailing Address - Phone:910-603-2788
Mailing Address - Fax:888-452-5964
Practice Address - Street 1:275 PINEHURST AVE STE B
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7138
Practice Address - Country:US
Practice Address - Phone:910-603-2788
Practice Address - Fax:888-452-5964
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211965225100000X
NCP18777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist