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General NPI Number Information
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NPI Number | 1225218563
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Entity Type | Organization
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Legal Business Name | LIVING ESSENCE PHYSICAL THERAPY & HERBAL PHARMACY, LLC
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Dates
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Enumeration Date | 11/04/2007
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Last Update Date | 11/04/2007
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Provider Practice Location Address
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Address Line | 38 BROWN ST 2ND FLOOR, FRONT
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-5039
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Country | US
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Telephone | 401-954-1807
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Fax | 401-295-5002
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Provider Business Mailing Address
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Address Line | 69 CHESTNUT RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-3904
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Country | US
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Telephone | 401-954-1807
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Fax | 401-295-5002
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Authorized Official
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Title or Position | OWNER/ PRACTIONER
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Name | MRS. KERRI LEE IALONGO GILLETTE
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Credential | PT
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Telephone | 401-954-1807
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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 | 1253
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License Number State | RI
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