Provider Demographics
NPI:1629851316
Name:PANAGIOTAKOPOULOS, GEORGE (PT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:PANAGIOTAKOPOULOS
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 1:92 MONTVALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3629
Mailing Address - Country:US
Mailing Address - Phone:781-279-7040
Mailing Address - Fax:
Practice Address - Street 1:405 PEARL ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6644
Practice Address - Country:US
Practice Address - Phone:781-279-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist