Provider Demographics
NPI:1407842297
Name:LEKOSIOTIS, HARRY JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:JOHN
Last Name:LEKOSIOTIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4634
Mailing Address - Country:US
Mailing Address - Phone:269-324-4333
Mailing Address - Fax:269-324-4343
Practice Address - Street 1:3930 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4634
Practice Address - Country:US
Practice Address - Phone:269-324-4333
Practice Address - Fax:269-324-4343
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP12580001Medicare ID - Type UnspecifiedINDEPENDENT PHYSICAL THER