Provider Demographics
NPI:1417475492
Name:GIOKAS, DEANNA EMILIA (LMT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:EMILIA
Last Name:GIOKAS
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 1:727 E LEWIS ST APT B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4924
Mailing Address - Country:US
Mailing Address - Phone:208-242-8911
Mailing Address - Fax:
Practice Address - Street 1:550 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4063
Practice Address - Country:US
Practice Address - Phone:208-282-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-2864225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty