Provider Demographics
NPI:1942313895
Name:KOULIAS, KATHRYN NIKOLAOS (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:NIKOLAOS
Last Name:KOULIAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:NIKOLAOS
Other - Last Name:DACTYLIDIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:700 N PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4419
Mailing Address - Country:US
Mailing Address - Phone:352-323-5610
Mailing Address - Fax:
Practice Address - Street 1:700 N PALMETTO ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4419
Practice Address - Country:US
Practice Address - Phone:352-323-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18884174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist