Healthcare Provider Details

I. General information

NPI: 1891453080
Provider Name (Legal Business Name): NICHOLAS PASQUARELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2021
Last Update Date: 12/04/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MAIN ST UNIT 9
EAST GREENWICH RI
02818-3163
US

IV. Provider business mailing address

251 WATERMAN ST
PROVIDENCE RI
02906-5235
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-4263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT02290
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: