Healthcare Provider Details

I. General information

NPI: 1255137980
Provider Name (Legal Business Name): SEAN MOWRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 RHODES AVE
WOONSOCKET RI
02895-2818
US

IV. Provider business mailing address

140 RHODES AVE
WOONSOCKET RI
02895-2818
US

V. Phone/Fax

Practice location:
  • Phone: 401-644-2887
  • Fax:
Mailing address:
  • Phone: 401-644-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA01060
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: