Provider Demographics
NPI:1750003166
Name:KOCOUREK, CHRISTINA (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KOCOUREK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 SW 172ND TER
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4559
Mailing Address - Country:US
Mailing Address - Phone:786-370-8736
Mailing Address - Fax:
Practice Address - Street 1:8901 SW 172ND TER
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4559
Practice Address - Country:US
Practice Address - Phone:786-370-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100987225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist