Provider Demographics
NPI:1801003868
Name:YANTSIOS, FOTINI (PT)
Entity Type:Individual
Prefix:
First Name:FOTINI
Middle Name:
Last Name:YANTSIOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PHOEBE
Other - Middle Name:
Other - Last Name:YANTSIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3009 CINIZA DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4614
Mailing Address - Country:US
Mailing Address - Phone:505-722-0070
Mailing Address - Fax:
Practice Address - Street 1:503 S. WILLIAMS ST.
Practice Address - Street 2:BLDG 16
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-722-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist