Provider Demographics
NPI:1811243512
Name:MAVROPOULOS, KONSTANTINOS (PT, DPT, FAAOMPT)
Entity type:Individual
Prefix:DR
First Name:KONSTANTINOS
Middle Name:
Last Name:MAVROPOULOS
Suffix:
Gender:M
Credentials:PT, DPT, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WASHINGTON ST
Mailing Address - Street 2:# 254
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4883
Mailing Address - Country:US
Mailing Address - Phone:201-655-8246
Mailing Address - Fax:
Practice Address - Street 1:330 WASHINGTON ST
Practice Address - Street 2:# 254
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4883
Practice Address - Country:US
Practice Address - Phone:201-655-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01451600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01451600OtherLICENSE NUMBER