Provider Demographics
NPI:1124314836
Name:KAKOS, CHRIS S (DPT)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:S
Last Name:KAKOS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46401 ROMEO PLANK RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-3510
Mailing Address - Country:US
Mailing Address - Phone:586-333-5704
Mailing Address - Fax:586-948-8008
Practice Address - Street 1:46401 ROMEO PLANK RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-3510
Practice Address - Country:US
Practice Address - Phone:586-333-5704
Practice Address - Fax:586-948-8008
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist