Provider Demographics
NPI:1497314306
Name:KOKOS, JOHN CONSTANTINE (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CONSTANTINE
Last Name:KOKOS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WATERFORD DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-8268
Mailing Address - Country:US
Mailing Address - Phone:717-620-7100
Mailing Address - Fax:717-620-7102
Practice Address - Street 1:21 WATERFORD DR STE 202
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-8268
Practice Address - Country:US
Practice Address - Phone:717-620-7100
Practice Address - Fax:717-620-7102
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027745208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation