Basic Information
Provider Information | |||||||||
NPI: | 1891869830 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PHYSIOTHERAPY ASSOCIATES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1160 POST RD | ||||||||
Address2: | SUITE 8 | ||||||||
City: | WARWICK | ||||||||
State: | RI | ||||||||
PostalCode: | 028883265 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4019419111 | ||||||||
FaxNumber: | 4019415906 | ||||||||
Practice Location | |||||||||
Address1: | 1160 POST RD | ||||||||
Address2: | SUITE 8 | ||||||||
City: | WARWICK | ||||||||
State: | RI | ||||||||
PostalCode: | 028883265 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4019419111 | ||||||||
FaxNumber: | 4019415906 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/20/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MASELLI | ||||||||
AuthorizedOfficialFirstName: | TANIA | ||||||||
AuthorizedOfficialMiddleName: | CARMELA | ||||||||
AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THEARPIST | ||||||||
AuthorizedOfficialTelephone: | 4019419111 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MS,OTRL | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X |   | RI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.