Basic Information
| Provider Information | |||||||||
| NPI: | 1891219317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATZINIKOLAU | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | EVANTHIA | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 PLAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023791325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7742813584 | ||||||||
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| Practice Location | |||||||||
| Address1: | 308 KINGSTOWN WAY | ||||||||
| Address2: | |||||||||
| City: | DUXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023324647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815855561 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2017 | ||||||||
| LastUpdateDate: | 07/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 9361 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.