Individual
MR. MARK LESLIE GEORGOPOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
225 15TH ST., ONAWA, IA 51040
(712) 423-2510
Mailing address
4428 NICOLLET WAY, SIOUX CITY, IA 51106-4333
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001583
IA
Other
Enumeration date
09/28/2011
Last updated
09/28/2011
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