Basic Information
| Provider Information | |||||||||
| NPI: | 1932230877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOLAN | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 SMITHFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028603497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017259666 | ||||||||
| FaxNumber: | 4017225896 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SMITHFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028603497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017259666 | ||||||||
| FaxNumber: | 4017272750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 03/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00438 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 402654 | 01 | RI | BLUE CROSS BS BLUE CHIP | OTHER |