Individual
JOANNA M. KOKOLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
4125 IRONBOUND RD, SUITE 100, WILLIAMSBURG, VA 23188-2666
(757) 220-8383
(757) 253-7833
Mailing address
771 PILOT HOUSE DR, SUITE A, NEWPORT NEWS, VA 23606-1990
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1158690
TX
225100000X
Physical Therapist
Primary
2305209311
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407934359
MEDICAID QMB
VA
01
—
C05954
MEDICARE GROUP PTAN
VA
Enumeration date
11/01/2006
Last updated
02/01/2017
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