Healthcare Provider Details

I. General information

NPI: 1215692652
Provider Name (Legal Business Name): ELIZABETH DILLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CHAPEL VIEW BLVD STE 140
CRANSTON RI
02920-3087
US

IV. Provider business mailing address

535 CENTERVILLE RD STE 101
WARWICK RI
02886-4376
US

V. Phone/Fax

Practice location:
  • Phone: 401-533-9616
  • Fax: 401-533-9631
Mailing address:
  • Phone: 401-737-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT03375
License Number StateRI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: