Provider Demographics
NPI:1689926735
Name:KARNOUPAKIS, MARK GREGORY (DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GREGORY
Last Name:KARNOUPAKIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-1619
Mailing Address - Country:US
Mailing Address - Phone:304-737-7299
Mailing Address - Fax:304-737-7356
Practice Address - Street 1:931 CHARLES ST
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1619
Practice Address - Country:US
Practice Address - Phone:304-737-7299
Practice Address - Fax:304-737-7356
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0132376Medicaid
WV3810029134Medicaid
WV3810029134Medicaid