Healthcare Provider Details

I. General information

NPI: 1811833239
Provider Name (Legal Business Name): CHRISTINA MARIE VENICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MANNING DR
RIVERSIDE RI
02915-3006
US

IV. Provider business mailing address

30 MANNING DR
RIVERSIDE RI
02915-3006
US

V. Phone/Fax

Practice location:
  • Phone: 401-413-0448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA00085
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: