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General NPI Number Information
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NPI Number | 1215401666
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Entity Type | Individual
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Provider Name | MARIOS CHRISTODOULOU PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 11/20/2021
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Provider Practice Location Address
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Address Line | 32 WASHINGTON ST STE 2A
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City | TENAFLY
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State | NJ
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Zip | 07670-3220
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Country | US
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Telephone | 201-565-6342
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Fax |
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Provider Business Mailing Address
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Address Line | 770 JACKSON ST APT 839
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City | HOBOKEN
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State | NJ
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Zip | 07030-6973
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Country | US
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Telephone | 201-565-6342
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01698400
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License Number State | NJ
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