Healthcare Provider Details

I. General information

NPI: 1790708444
Provider Name (Legal Business Name): KIM MARIE R DUMAS MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 5TH AVE
EAST GREENWICH RI
02818-3108
US

IV. Provider business mailing address

19 FIRWOOD DR
NORTH KINGSTOWN RI
02852-1725
US

V. Phone/Fax

Practice location:
  • Phone: 401-884-9541
  • Fax: 401-884-9509
Mailing address:
  • Phone: 401-886-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT01317
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: