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General NPI Number Information
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NPI Number | 1174850200
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Entity Type | Individual
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Provider Name | JEROME ANTHONY RAO D.P.T.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 200 HIGH SERVICE AVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-5113
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Country | US
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Telephone | 401-456-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 182 SUTTON AVE APARTMENT 1
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-3418
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Country | US
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Telephone | 718-309-8193
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT02243
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License Number State | RI
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