Basic Information
| Provider Information | |||||||||
| NPI: | 1023213352 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEVINE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 FOX RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028981160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015397381 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | COVENTRY | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028166716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018262000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00524 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.