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General NPI Number Information
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NPI Number | 1376747659
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Entity Type | Individual
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Provider Name | STEPHEN MICHAEL MEDEIROS PTA
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Gender | Male
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 642 METACOM AVE
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City | WARREN
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State | RI
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Zip | 02885-2350
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Country | US
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Telephone | 401-245-2860
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Fax | 401-245-0959
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Provider Business Mailing Address
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Address Line | 6 JENNY LN
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City | BRISTOL
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State | RI
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Zip | 02809-4138
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA00398
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License Number State | RI
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