Provider Demographics
NPI:1972121846
Name:SGOURAKIS, KOSTANTINA
Entity type:Individual
Prefix:
First Name:KOSTANTINA
Middle Name:
Last Name:SGOURAKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:SGOURAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:701 PINNACLE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-6228
Mailing Address - Country:US
Mailing Address - Phone:402-505-7989
Mailing Address - Fax:402-932-8863
Practice Address - Street 1:701 PINNACLE DR STE 105
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-6228
Practice Address - Country:US
Practice Address - Phone:402-505-7989
Practice Address - Fax:402-932-8863
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2833225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist