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General NPI Number Information
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NPI Number | 1508852955
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Entity Type | Individual
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Provider Name | LISA CLANCY DPT
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Gender | Female
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 227 CENTERVILLE RD FL 2
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City | WARWICK
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State | RI
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Zip | 02886-4394
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Country | US
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Telephone | 401-732-8200
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Fax | 401-732-8230
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Provider Business Mailing Address
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Address Line | 227 CENTERVILLE RD FL 2
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City | WARWICK
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State | RI
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Zip | 02886-4394
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Country | US
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Telephone | 401-732-8200
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Fax | 401-732-8230
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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 | PT00965
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License Number State | RI
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