Healthcare Provider Details

I. General information

NPI: 1982531190
Provider Name (Legal Business Name): LAURA JEAN LEE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 PAWTUCKET AVE
PAWTUCKET RI
02860-6057
US

IV. Provider business mailing address

282 PROSPECT RD
WAKEFIELD RI
02879-7060
US

V. Phone/Fax

Practice location:
  • Phone: 401-475-3580
  • Fax:
Mailing address:
  • Phone: 401-475-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA00509
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: