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General NPI Number Information
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NPI Number | 1881833630
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Entity Type | Individual
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Provider Name | SUSAN RAND CELICO PT
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Gender | Female
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 140 POINT JUDITH RD UNIT A13
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City | NARRAGANSETT
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State | RI
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Zip | 02882-3451
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Country | US
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Telephone | 401-792-0900
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Fax | 401-792-0901
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Provider Business Mailing Address
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Address Line | 38 ANDRE AVE
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City | WAKEFIELD
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State | RI
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Zip | 02879-1513
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Country | US
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Telephone | 401-212-9000
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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 | PT00442
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License Number State | RI
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