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General NPI Number Information
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NPI Number | 1801940317
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Entity Type | Individual
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Provider Name | GINA STOPPOLONI STATHACOPOULOS PT MA PT GDMT
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 1670 S AMPHLETT BLVD SUITE 123
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City | SAN MATEO
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State | CA
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Zip | 94402-2510
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Country | US
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Telephone | 650-558-0247
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Fax | 650-558-1735
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Provider Business Mailing Address
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Address Line | 1670 S AMPHLETT BLVD SUITE 123
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City | SAN MATEO
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State | CA
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Zip | 94402-2510
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Country | US
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Telephone | 650-558-0247
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Fax | 650-558-1735
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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 | PT24571
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License Number State | CA
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