Healthcare Provider Details

I. General information

NPI: 1679736458
Provider Name (Legal Business Name): DANA R EKELUND LMT,CNMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 RESERVOIR AVE SUITE 300
CRANSTON RI
02920-6055
US

IV. Provider business mailing address

1145 RESERVOIR AVE SUITE 300
CRANSTON RI
02920-6055
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-2500
  • Fax:
Mailing address:
  • Phone: 401-943-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT00778
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: