Provider Demographics
NPI:1740356062
Name:IACOVOU, EPAMINONDAS PANAYIOTIS (PT)
Entity type:Individual
Prefix:MR
First Name:EPAMINONDAS
Middle Name:PANAYIOTIS
Last Name:IACOVOU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:EPAMINONDAS
Other - Middle Name:PANAYIOTIS
Other - Last Name:IACOVOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:136A LORENZO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-6118
Mailing Address - Country:US
Mailing Address - Phone:505-820-3336
Mailing Address - Fax:
Practice Address - Street 1:435 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7672
Practice Address - Country:US
Practice Address - Phone:505-984-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1932284122OtherRMSI NPI
NM1932284122OtherRMSI NPI