Provider Demographics
NPI:1699867671
Name:LIATSOS, NICHOLAS STAUROS (PT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:STAUROS
Last Name:LIATSOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 FRENCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1802
Mailing Address - Country:US
Mailing Address - Phone:401-884-6456
Mailing Address - Fax:401-884-3210
Practice Address - Street 1:99 FRENCHTOWN RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1802
Practice Address - Country:US
Practice Address - Phone:401-884-6456
Practice Address - Fax:401-884-3210
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist