Provider Demographics
NPI:1700937927
Name:BACKERIS, EFTHEMIA TAMMY (HIS)
Entity Type:Individual
Prefix:
First Name:EFTHEMIA
Middle Name:TAMMY
Last Name:BACKERIS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:EFTHEMIA
Other - Middle Name:TAMMY
Other - Last Name:BOUZOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:111 FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7100
Mailing Address - Country:US
Mailing Address - Phone:724-387-3073
Mailing Address - Fax:412-291-3109
Practice Address - Street 1:2566 HAYMAKER RD
Practice Address - Street 2:SUITE 214
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3517
Practice Address - Country:US
Practice Address - Phone:724-387-3073
Practice Address - Fax:412-291-3109
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03293237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist