Provider Demographics
NPI:1588804520
Name:CHRISTOPOULOS, IOULIA M (DPT)
Entity Type:Individual
Prefix:
First Name:IOULIA
Middle Name:M
Last Name:CHRISTOPOULOS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:IOULIA
Other - Middle Name:M
Other - Last Name:FUDUKOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:800 DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4760
Mailing Address - Country:US
Mailing Address - Phone:847-292-4710
Mailing Address - Fax:847-292-4903
Practice Address - Street 1:800 DEVON AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4760
Practice Address - Country:US
Practice Address - Phone:847-292-4710
Practice Address - Fax:847-292-4903
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0016940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist