Provider Demographics
NPI:1235311218
Name:VASALOS, KOSTANTINOS
Entity Type:Individual
Prefix:MR
First Name:KOSTANTINOS
Middle Name:
Last Name:VASALOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 LACDEVILLE BLVD
Mailing Address - Street 2:BUILDING D SUITE 110
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5647
Mailing Address - Country:US
Mailing Address - Phone:585-341-9150
Mailing Address - Fax:
Practice Address - Street 1:4901 LACDEVILLE BLVD
Practice Address - Street 2:BUILDING D SUITE 110
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5647
Practice Address - Country:US
Practice Address - Phone:585-341-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0263322251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports