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NPI Code Detail

MEDICARE: DR. DIMITRIOS KOSTOPOULOS PT, PHD, DSC, ECS

MEDICARE: DR. DIMITRIOS KOSTOPOULOS PT, PHD, DSC, ECS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT11118FL
2225100000XPhysical Therapist011188-1NY

General Provider Information

NPI Number : 1801834734
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIMITRIOS KOSTOPOULOS PT, PHD, DSC, ECS
Provider Business Mailing Address
First Line : 3244 31ST ST
Second Line :
City : ASTORIA
State : NY
Zip : 11106-2561
Country : US
Telephone Number : 718-707-6970
Fax Number : 718-707-6977
Provider Business Practice Location Address
First Line : 3244 31ST ST
Second Line :
City : ASTORIA
State : NY
Zip : 11106-2561
Country : US
Telephone Number : 718-707-6970
Fax Number : 929-208-0767
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2006
Last Update Date : 04/24/2024

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