Provider Demographics
NPI:1205472909
Name:FLANAGAN KOKKO, JANINE (DPT)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:FLANAGAN KOKKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 LESESNE ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7314
Mailing Address - Country:US
Mailing Address - Phone:843-270-0245
Mailing Address - Fax:833-787-9691
Practice Address - Street 1:421 LESESNE ST
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7314
Practice Address - Country:US
Practice Address - Phone:843-270-0245
Practice Address - Fax:833-787-9691
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist