Healthcare Provider Details

I. General information

NPI: 1770557902
Provider Name (Legal Business Name): ROBERT JOSEPH SCLAMA JR. MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 WENSCOTT LN
NORTH PROVIDENCE RI
02904-3824
US

IV. Provider business mailing address

46 WENSCOTT LN
NORTH PROVIDENCE RI
02904-3824
US

V. Phone/Fax

Practice location:
  • Phone: 401-354-6289
  • Fax:
Mailing address:
  • Phone: 401-354-6289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-01733
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19965
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: