Basic Information
| Provider Information | |||||||||
| NPI: | 1053566372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAPOSA | ||||||||
| FirstName: | INA | ||||||||
| MiddleName: | FRANCES | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PIMENTAL | ||||||||
| OtherFirstName: | INA | ||||||||
| OtherMiddleName: | FRANCES | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1181 AQUIDNECK AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018450840 | ||||||||
| FaxNumber: | 4018450842 | ||||||||
| Practice Location | |||||||||
| Address1: | 1812 MAIN RD | ||||||||
| Address2: | |||||||||
| City: | TIVERTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028784625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016259855 | ||||||||
| FaxNumber: | 4016259856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2008 | ||||||||
| LastUpdateDate: | 12/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT02192 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 21378 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT02192 | 01 | RI | RHODE ISLAND PT LIC. | OTHER | 21378 | 01 | MA | MA LIC | OTHER | 1053566372 | 01 | RI | TYPE 1 NPI | OTHER |