Provider Demographics
NPI:1801464599
Name:LAGOGIANNIS, EMMANOUIL (PT, MSC)
Entity type:Individual
Prefix:
First Name:EMMANOUIL
Middle Name:
Last Name:LAGOGIANNIS
Suffix:
Gender:M
Credentials:PT, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HILLSYDE CT
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1750
Mailing Address - Country:US
Mailing Address - Phone:443-355-8891
Mailing Address - Fax:
Practice Address - Street 1:10155 YORK RD STE 205-206
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3352
Practice Address - Country:US
Practice Address - Phone:443-355-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist