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General NPI Number Information
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NPI Number | 1033766985
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Entity Type | Individual
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Provider Name | BRITANY MICHELLE GONSALVES PTA
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Gender | Female
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 600 VALLEY RD
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City | MIDDLETOWN
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State | RI
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Zip | 02842-7029
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Country | US
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Telephone | 401-846-0743
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Fax |
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Provider Business Mailing Address
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Address Line | 104 WILBUR ST APT 3
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City | FALL RIVER
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State | MA
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Zip | 02724-6239
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Country | US
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Telephone | 401-835-2742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PTA01165
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License Number State | RI
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