Healthcare Provider Details

I. General information

NPI: 1962023093
Provider Name (Legal Business Name): AL FANTASIA RRT-NPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 PARK ST
HYANNIS MA
02601-5230
US

IV. Provider business mailing address

27 PARK ST
HYANNIS MA
02601-5230
US

V. Phone/Fax

Practice location:
  • Phone: 508-862-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT2863
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License NumberRT2863
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License NumberRT2863
License Number State
# 4
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT2863
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: