Healthcare Provider Details

I. General information

NPI: 1689141608
Provider Name (Legal Business Name): NIKOLAS XENOPOULOS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 LONG POND RD
ROCHESTER NY
14612-3005
US

IV. Provider business mailing address

515 LONG POND RD
ROCHESTER NY
14612-3005
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-2310
  • Fax: 585-227-2312
Mailing address:
  • Phone: 585-227-2310
  • Fax: 585-227-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number043519
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: