Healthcare Provider Details

I. General information

NPI: 1194775007
Provider Name (Legal Business Name): KATHLEEN M MULDOWNEY MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN M DEMLING MSPT

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 RESERVOIR AVE
CRANSTON RI
02910-4430
US

IV. Provider business mailing address

721 RESERVOIR AVE
CRANSTON RI
02910-4430
US

V. Phone/Fax

Practice location:
  • Phone: 401-946-4250
  • Fax: 401-275-5645
Mailing address:
  • Phone: 401-946-4250
  • Fax: 401-275-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT01748
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: