Provider Demographics
NPI:1467672840
Name:KYPRIANOU, MARIOS (PT)
Entity Type:Individual
Prefix:MR
First Name:MARIOS
Middle Name:
Last Name:KYPRIANOU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 VILLAGE BEND DR
Mailing Address - Street 2:APT. #910
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-3700
Mailing Address - Country:US
Mailing Address - Phone:214-769-8623
Mailing Address - Fax:
Practice Address - Street 1:8615 FREEPORT PKWY
Practice Address - Street 2:#225
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2576
Practice Address - Country:US
Practice Address - Phone:972-812-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist