Mark Leslie Georgopoulos, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

001583 Issued in IA

Practice address

225 15TH St.
Onawa, IA 51040

Phone

(712) 423-2510

NPI assigned

Sep 28, 2011

Last updated

Sep 28, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317168000000",
    "number": "1083997811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4428 NICOLLET WAY",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511064333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 15TH ST.",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "51040",
            "telephone_number": "712-423-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEORGOPOULOS",
        "first_name": "MARK",
        "middle_name": "LESLIE",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-28",
        "last_updated": "2011-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IA",
            "license": "001583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Onawa, IA
• Providers in Onawa, IA by specialty
• Physical Therapy Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.