Provider Demographics
NPI:1891042180
Name:SOTERAKOPOULOS, CHRISTOPHER (DPT, FAFS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SOTERAKOPOULOS
Suffix:
Gender:M
Credentials:DPT, FAFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 122ND PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6295
Mailing Address - Country:US
Mailing Address - Phone:360-471-1919
Mailing Address - Fax:425-355-5231
Practice Address - Street 1:15 SW EVERETT MALL WAY
Practice Address - Street 2:STE G
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-2715
Practice Address - Country:US
Practice Address - Phone:425-355-5222
Practice Address - Fax:425-355-5231
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60284835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8945734Medicare PIN