Healthcare Provider Details

I. General information

NPI: 1033611892
Provider Name (Legal Business Name): RHODE ISLAND LIMB CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 VALLEY RD STE 101
MIDDLETOWN RI
02842-6371
US

IV. Provider business mailing address

1559 ELMWOOD AVE
CRANSTON RI
02910-3845
US

V. Phone/Fax

Practice location:
  • Phone: 401-619-4639
  • Fax: 401-619-2333
Mailing address:
  • Phone: 401-941-6230
  • Fax: 401-941-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT02094
License Number StateRI

VIII. Authorized Official

Name: MR. JONATHAN TEOLI
Title or Position: PRESIDENT
Credential:
Phone: 401-941-6230