Healthcare Provider Details

I. General information

NPI: 1568729671
Provider Name (Legal Business Name): ELIZABETH KATHERINE FLYNN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MAPLE AVE SUITE 104
BARRINGTON RI
02806-3430
US

IV. Provider business mailing address

310 MAPLE AVE SUITE 104
BARRINGTON RI
02806-3430
US

V. Phone/Fax

Practice location:
  • Phone: 401-247-0500
  • Fax: 401-247-0507
Mailing address:
  • Phone: 401-247-0500
  • Fax: 401-247-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT02472
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: