MEDICARE: CHARLES J CARUSO PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	00633	RI
2	225200000X	Physical Therapy Assistant	2517	MA

General Provider Information

NPI Number	:	1073639639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES J CARUSO PTA

Provider Business Mailing Address
First Line	:	159 OLD COUNTY RD
Second Line	:
City	:	SMITHFIELD
State	:	RI
Zip	:	02917-2909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 COMMONWEALTH AVE
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2707
Country	:	US
Telephone Number	:	401-691-4511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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