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NPI Code Detail

MEDICARE: MR. STEPHEN MICHAEL MEDEIROS PTA

MEDICARE: MR. STEPHEN MICHAEL MEDEIROS 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
1225200000XPhysical Therapy AssistantPTA00398RI

General Provider Information

NPI Number : 1376747659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN MICHAEL MEDEIROS PTA
Provider Business Mailing Address
First Line : 6 JENNY LN
Second Line :
City : BRISTOL
State : RI
Zip : 02809-4138
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 642 METACOM AVE
Second Line :
City : WARREN
State : RI
Zip : 02885-2350
Country : US
Telephone Number : 401-245-2860
Fax Number : 401-245-0959
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2007
Last Update Date : 07/08/2007

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