Healthcare Provider Details

I. General information

NPI: 1710807607
Provider Name (Legal Business Name): DIMITRIOS ASANAKIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CROSS ST STE 302
PEABODY MA
01960-1689
US

IV. Provider business mailing address

39 CROSS ST STE 302
PEABODY MA
01960-1689
US

V. Phone/Fax

Practice location:
  • Phone: 978-880-1245
  • Fax:
Mailing address:
  • Phone: 978-880-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18844-MT-MT
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: