=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538299219
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH SARDELLI PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 STILSON RD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-539-4600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 DORMAR RD
-----------------------------------------------------
City | HOPE VALLEY
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02832-2434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-364-5927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | PT01362
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------