Healthcare Provider Details

I. General information

NPI: 1871456103
Provider Name (Legal Business Name): ANTHONY WILLIAM CRAINE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 BRANCH AVE
PROVIDENCE RI
02904-2713
US

IV. Provider business mailing address

67 TIFFT RD
NORTH SMITHFIELD RI
02896-8009
US

V. Phone/Fax

Practice location:
  • Phone: 401-722-8880
  • Fax:
Mailing address:
  • Phone: 401-440-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number00965
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: