MEDICARE: JONIS CHATZIGIANNIDIS LPED, DOMP, MT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	26	OK
2	224L00000X	Pedorthist	26	OK
3	225000000X	Orthotic Fitter	26	OK
4	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
5	174400000X	Specialist	26	OK
6	225700000X	Massage Therapist	157326	OK

General Provider Information

NPI Number	:	1992772917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONIS CHATZIGIANNIDIS LPED, DOMP, MT

Provider Business Mailing Address
First Line	:	6465 S YALE AVE
Second Line	:	SUITE 608
City	:	TULSA
State	:	OK
Zip	:	74136
Country	:	US
Telephone Number	:	918-747-8224
Fax Number	:	918-296-3587

Provider Business Practice Location Address
First Line	:	6465 S YALE AVE STE 608
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7808
Country	:	US
Telephone Number	:	918-747-8224
Fax Number	:	918-935-3499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	08/28/2024

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Directions to “ JONIS CHATZIGIANNIDIS LPED, DOMP, MT” Practice Location

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