Healthcare Provider Details

I. General information

NPI: 1548227200
Provider Name (Legal Business Name): WILLIAM J POIRIER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 MAIN RD
TIVERTON RI
02878-4625
US

IV. Provider business mailing address

1181 AQUIDNECK AVE
MIDDLETOWN RI
02842-5255
US

V. Phone/Fax

Practice location:
  • Phone: 401-625-1539
  • Fax: 401-625-9856
Mailing address:
  • Phone: 401-845-0840
  • Fax: 401-619-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00599
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: