Provider Demographics
NPI:1700225026
Name:VASILAKIS, JOHN II (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:VASILAKIS
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 WHITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5441
Mailing Address - Country:US
Mailing Address - Phone:843-229-1022
Mailing Address - Fax:
Practice Address - Street 1:446 WHITMAN AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5441
Practice Address - Country:US
Practice Address - Phone:843-229-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2735225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant