Healthcare Provider Details

I. General information

NPI: 1881396570
Provider Name (Legal Business Name): PETER THOMAS SAUVAGEAU PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 COMMONWEALTH AVE
WARWICK RI
02886-2707
US

IV. Provider business mailing address

3 HOPE CT
WEST WARWICK RI
02893-5916
US

V. Phone/Fax

Practice location:
  • Phone: 401-739-4241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA00991
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: