Basic Information
| Provider Information | |||||||||
| NPI: | 1619481728 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | D'ELIA | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 CENTERVILLE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017376011 | ||||||||
| FaxNumber: | 4017374811 | ||||||||
| Practice Location | |||||||||
| Address1: | 618 GEORGE WASHINGTON HWY | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028654216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014756599 | ||||||||
| FaxNumber: | 4014756429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | PT02997 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT02997 | 01 | RI | STATE LICENSE | OTHER |