Healthcare Provider Details

I. General information

NPI: 1619322963
Provider Name (Legal Business Name): CHERYL DIANE PICARD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 04/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 CHURCH AVE
WARWICK RI
02889-3203
US

IV. Provider business mailing address

568 CHURCH AVE
WARWICK RI
02889-3203
US

V. Phone/Fax

Practice location:
  • Phone: 401-426-9416
  • Fax:
Mailing address:
  • Phone: 401-426-9416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA00358
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: