Provider Demographics
NPI:1184788663
Name:BOLOS, CONSTANTINE P (PT)
Entity type:Individual
Prefix:MR
First Name:CONSTANTINE
Middle Name:P
Last Name:BOLOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 E BEST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1621
Mailing Address - Country:US
Mailing Address - Phone:847-398-2656
Mailing Address - Fax:
Practice Address - Street 1:3300 KIRCHOFF RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1824
Practice Address - Country:US
Practice Address - Phone:847-618-3880
Practice Address - Fax:847-618-3889
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist