Basic Information
| Provider Information | |||||||||
| NPI: | 1801945266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NTELEKOS | ||||||||
| FirstName: | KOSTANTINOS | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 WHITE HORSE RD E | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080432601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564352323 | ||||||||
| FaxNumber: | 8564352326 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 WHITE HORSE RD E | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080432601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564352323 | ||||||||
| FaxNumber: | 8564352326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00963300 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT016841 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.