Provider Demographics
NPI:1922612613
Name:KAROUTSOS, MIA VIOLETTA (LMT, CMLD)
Entity Type:Individual
Prefix:MS
First Name:MIA
Middle Name:VIOLETTA
Last Name:KAROUTSOS
Suffix:
Gender:F
Credentials:LMT, CMLD
Other - Prefix:MS
Other - First Name:MIA
Other - Middle Name:VIOLETTA
Other - Last Name:KAROUTSOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, CMLD
Mailing Address - Street 1:5920 BURR OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:IL
Mailing Address - Zip Code:60163-1425
Mailing Address - Country:US
Mailing Address - Phone:312-927-1377
Mailing Address - Fax:
Practice Address - Street 1:5920 BURR OAK AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:IL
Practice Address - Zip Code:60163-1425
Practice Address - Country:US
Practice Address - Phone:312-927-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist