Healthcare Provider Details

I. General information

NPI: 1770197782
Provider Name (Legal Business Name): MARY SHIEL-L'ESPERANCE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 KNIGHT ST BLDG F22
WARWICK RI
02886-1281
US

IV. Provider business mailing address

904 LAPHAM FARM RD
MAPLEVILLE RI
02839-1229
US

V. Phone/Fax

Practice location:
  • Phone: 401-231-7100
  • Fax:
Mailing address:
  • Phone: 401-636-2142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00543
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: