Provider Demographics
NPI:1801414875
Name:CHIRAKOS, ANASTASIA EVEMARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANASTASIA
Middle Name:EVEMARIE
Last Name:CHIRAKOS
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 1:6151 AVERY RD STE B
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9614
Mailing Address - Country:US
Mailing Address - Phone:614-975-4579
Mailing Address - Fax:
Practice Address - Street 1:6151 AVERY RD STE B
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9614
Practice Address - Country:US
Practice Address - Phone:614-975-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.024556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0163947Medicaid