Provider Demographics
NPI:1275019184
Name:HATZILIAS, CHRYSOULA (LMT)
Entity Type:Individual
Prefix:
First Name:CHRYSOULA
Middle Name:
Last Name:HATZILIAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6971 LAKEVIEW BLVD APT 2113
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2280
Mailing Address - Country:US
Mailing Address - Phone:248-761-7774
Mailing Address - Fax:
Practice Address - Street 1:6971 LAKEVIEW BLVD APT 2113
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2280
Practice Address - Country:US
Practice Address - Phone:248-761-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000487225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist