Provider Demographics
NPI:1538189949
Name:TRIANTIS, ELENI M (DPT)
Entity type:Individual
Prefix:
First Name:ELENI
Middle Name:M
Last Name:TRIANTIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4895
Mailing Address - Country:US
Mailing Address - Phone:301-698-9956
Mailing Address - Fax:301-698-9957
Practice Address - Street 1:75 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE L
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4895
Practice Address - Country:US
Practice Address - Phone:301-698-9956
Practice Address - Fax:301-698-9957
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist