Provider Demographics
NPI:1316019615
Name:KOTSAPOUIKIS, DESPINA GEORGE (PT)
Entity Type:Individual
Prefix:MISS
First Name:DESPINA
Middle Name:GEORGE
Last Name:KOTSAPOUIKIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1850 N CLARK ST
Mailing Address - Street 2:APT. 406
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5301
Mailing Address - Country:US
Mailing Address - Phone:847-772-8145
Mailing Address - Fax:312-238-1214
Practice Address - Street 1:345 E SUPERIOR ST
Practice Address - Street 2:12TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2654
Practice Address - Country:US
Practice Address - Phone:312-238-6171
Practice Address - Fax:312-238-1214
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist