Basic Information
| Provider Information | |||||||||
| NPI: | 1821000589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LACHUT | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51SOCKANOSSET CROSS RD | ||||||||
| Address2: | |||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029205558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019447574 | ||||||||
| FaxNumber: | 4019447602 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 SOCKANOSSET CROSS RD | ||||||||
| Address2: | |||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029205536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019447574 | ||||||||
| FaxNumber: | 4019447602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 09/16/2013 | ||||||||
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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 | PTO1574 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT01574 | 01 | RI | PT NUMBER | OTHER |