Provider Demographics
NPI:1346486073
Name:PETROPOULOS, GEORGINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:PETROPOULOS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 ROUTE 18
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4910
Mailing Address - Country:US
Mailing Address - Phone:732-254-0090
Mailing Address - Fax:732-254-2292
Practice Address - Street 1:758 ROUTE 18
Practice Address - Street 2:SUITE 106
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4910
Practice Address - Country:US
Practice Address - Phone:732-254-0090
Practice Address - Fax:732-254-2292
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01294400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist