Provider Demographics
NPI:1275171332
Name:ECONOMOU, VICKI (LMT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:ECONOMOU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NEW ORLEANS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4793
Mailing Address - Country:US
Mailing Address - Phone:843-785-7822
Mailing Address - Fax:
Practice Address - Street 1:55 NEW ORLEANS RD STE 202
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4793
Practice Address - Country:US
Practice Address - Phone:843-785-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1206225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty