Healthcare Provider Details

I. General information

NPI: 1912026048
Provider Name (Legal Business Name): MICHELLE ELIZABETH NARDELLI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 COMMONWEALTH AVE
WARWICK RI
02886-2707
US

IV. Provider business mailing address

6 NOTTINGHAM DR
LINCOLN RI
02865-1646
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-4241
  • Fax:
Mailing address:
  • Phone: 401-724-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA0606
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: