Basic Information
| Provider Information | |||||||||
| NPI: | 1619984325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NULA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 CENTERVILLE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017374581 | ||||||||
| FaxNumber: | 4017376152 | ||||||||
| Practice Location | |||||||||
| Address1: | 535 CENTERVILLE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017374581 | ||||||||
| FaxNumber: | 4017376152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT01641 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 22765-2 | 01 | RI | BC/BS OF RI | OTHER | 408470 | 01 | RI | BLUE CHIP OF RI | OTHER | 7998330 | 01 | AETNA | OTHER |