Provider Demographics
NPI:1407934359
Name:KOKOLIS, JOANNA M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:KOKOLIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:U
Other - Last Name:MICHALOPULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:4125 IRONBOUND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2666
Practice Address - Country:US
Practice Address - Phone:757-220-8383
Practice Address - Fax:757-253-7833
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158690225100000X
VA2305209311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05954OtherMEDICARE GROUP PTAN
VA1407934359OtherMEDICAID QMB
TX8D7577Medicare PIN
TX00500NMedicare PIN
VAC05954OtherMEDICARE GROUP PTAN