Provider Demographics
NPI:1376624528
Name:KONOPASKY, PAUL WILLIAM (RPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WILLIAM
Last Name:KONOPASKY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24431 CALLE DE LA LOUISA
Mailing Address - Street 2:200
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7641
Mailing Address - Country:US
Mailing Address - Phone:949-837-2113
Mailing Address - Fax:949-837-2040
Practice Address - Street 1:24431 CALLE DE LA LOUISA
Practice Address - Street 2:200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7641
Practice Address - Country:US
Practice Address - Phone:949-837-2113
Practice Address - Fax:949-837-2040
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS25022Medicare UPIN
CAWPT15952AMedicare ID - Type Unspecified