Provider Demographics
NPI:1154029296
Name:PETROU, ELENI
Entity type:Individual
Prefix:
First Name:ELENI
Middle Name:
Last Name:PETROU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 S LUMPKIN ST APT 309
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5291
Mailing Address - Country:US
Mailing Address - Phone:706-714-4243
Mailing Address - Fax:
Practice Address - Street 1:2375 S LUMPKIN ST APT 309
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5291
Practice Address - Country:US
Practice Address - Phone:706-714-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0038362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer