Provider Demographics
NPI:1346369063
Name:PAPADAKOS, STAVROULA LIOGAS (PT)
Entity Type:Individual
Prefix:
First Name:STAVROULA
Middle Name:LIOGAS
Last Name:PAPADAKOS
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 1:145 FORT DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1030
Mailing Address - Country:US
Mailing Address - Phone:313-563-0448
Mailing Address - Fax:
Practice Address - Street 1:1700 BIDDLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-7205
Practice Address - Country:US
Practice Address - Phone:734-284-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist