Provider Demographics
NPI:1053185736
Name:ANDRIAKOS, ATHENA (LMT)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:ANDRIAKOS
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 1:4804 SOLECITO CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2779
Mailing Address - Country:US
Mailing Address - Phone:928-266-5511
Mailing Address - Fax:
Practice Address - Street 1:1640 OLD PECOS TRL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4776
Practice Address - Country:US
Practice Address - Phone:505-372-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT9586225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist