Provider Demographics
NPI:1124186390
Name:KOURMOLIS, MARIA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KOURMOLIS
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 1:3822 AVENUE T
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4934
Mailing Address - Country:US
Mailing Address - Phone:917-981-4834
Mailing Address - Fax:
Practice Address - Street 1:2915 AVENUE S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2544
Practice Address - Country:US
Practice Address - Phone:718-554-3680
Practice Address - Fax:718-874-2625
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ31F4OtherEMPIRE BLUE CROSSBLUESHIE
NYQ31F4OtherEMPIRE BLUE CROSSBLUESHIE