Provider Demographics
NPI:1477813871
Name:KOUKOUVES, GEORGE (LMT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:KOUKOUVES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15734 E SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4371
Mailing Address - Country:US
Mailing Address - Phone:480-836-6888
Mailing Address - Fax:480-836-6888
Practice Address - Street 1:36800 N. SIDEWINDER
Practice Address - Street 2:A-8
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377
Practice Address - Country:US
Practice Address - Phone:480-363-0091
Practice Address - Fax:480-575-1181
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-03432P172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist