Provider Demographics
NPI:1083001184
Name:ANDREOULAKIS, EMMANUEL (MS, ATC/LAT, PES)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:
Last Name:ANDREOULAKIS
Suffix:
Gender:M
Credentials:MS, ATC/LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GOFF AVE UNIT 6101
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-9202
Mailing Address - Country:US
Mailing Address - Phone:401-338-3105
Mailing Address - Fax:
Practice Address - Street 1:235 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02912-9090
Practice Address - Country:US
Practice Address - Phone:401-338-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT003292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer