Healthcare Provider Details

I. General information

NPI: 1316141435
Provider Name (Legal Business Name): NICOLE RENEE TREMBLAY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GARNETT LN
GREENVILLE RI
02828-1529
US

IV. Provider business mailing address

ONE GARNETT LANE
GREENVILLE RI
02828-1414
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-0380
  • Fax: 401-949-5581
Mailing address:
  • Phone: 401-949-0380
  • Fax: 401-949-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT01251
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: