Provider Demographics
NPI:1083500623
Name:KONTOS, JEROME K (LMT)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:K
Last Name:KONTOS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:KONTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:5220 HARTFORD ST APT 910
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-3504
Mailing Address - Country:US
Mailing Address - Phone:480-272-8293
Mailing Address - Fax:
Practice Address - Street 1:1290 S WILLIS ST STE 124
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4064
Practice Address - Country:US
Practice Address - Phone:325-673-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT132932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist