Basic Information
| Provider Information | |||||||||
| NPI: | 1548227200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POIRIER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1181 AQUIDNECK AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018450840 | ||||||||
| FaxNumber: | 4016193752 | ||||||||
| Practice Location | |||||||||
| Address1: | 1808 MAIN RD | ||||||||
| Address2: | |||||||||
| City: | TIVERTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028784625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016251539 | ||||||||
| FaxNumber: | 4016259856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 10/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00599 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT00599 | 01 | RI | TRI-CARE | OTHER | 64-00296 | 01 | RI | UNITED HEALTH | OTHER | 402473 | 01 | RI | BLUE CHIP RI | OTHER | 22645-3 | 01 | RI | BLUE CROSS BLUE SHEILD | OTHER | 13859 | 01 | RI | NEIGHBORHOOD HEALTH PLAN | OTHER |