Provider Demographics
NPI:1265535892
Name:ELIOPOULOS, ATHENA ARISTIDES (PT)
Entity type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:ARISTIDES
Last Name:ELIOPOULOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARRICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3850
Mailing Address - Country:US
Mailing Address - Phone:401-463-3060
Mailing Address - Fax:401-463-9990
Practice Address - Street 1:100 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:WARRICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3850
Practice Address - Country:US
Practice Address - Phone:401-463-3060
Practice Address - Fax:401-463-9990
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412635OtherBLUE CROSS
RI6400223OtherUNITED
RI75428OtherBLUE CROSS