Healthcare Provider Details

I. General information

NPI: 1831724269
Provider Name (Legal Business Name): MADDYS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 HARTFORD AVE
JOHNSTON RI
02919-7137
US

IV. Provider business mailing address

10 FRANCES DR
CRANSTON RI
02920-1345
US

V. Phone/Fax

Practice location:
  • Phone: 401-451-5636
  • Fax:
Mailing address:
  • Phone: 401-451-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. AMERICO TESTA
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 401-451-5636