Provider Demographics
NPI:1316936271
Name:KARAGIANNOPOULOS, CHRISTOS (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOS
Middle Name:
Last Name:KARAGIANNOPOULOS
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1812 MARSH RD
Practice Address - Street 2:STORE 505
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4581
Practice Address - Country:US
Practice Address - Phone:302-475-7500
Practice Address - Fax:302-475-5787
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012595L225100000X
DEJ1-0002359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1316936271OtherTRICARE CHAMPUS
DE1316936271Medicaid
PA038381VKFMedicare PIN
038381Medicare ID - Type Unspecified
P00635530Medicare PIN
P07825Medicare UPIN
DE129305Y0XMedicare PIN