MEDICARE: ELEANOR DEREDITA DPT

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	225100000X	Physical Therapist	PT0285	RI

General Provider Information

NPI Number	:	1679189427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR DEREDITA DPT

Provider Business Mailing Address
First Line	:	81 BEACH ST
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891-2784
Country	:	US
Telephone Number	:	401-596-3593
Fax Number	:	401-596-3789

Provider Business Practice Location Address
First Line	:	81 BEACH ST
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891-2784
Country	:	US
Telephone Number	:	401-596-3593
Fax Number	:	401-596-3789

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

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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Directions to “ ELEANOR DEREDITA DPT” Practice Location

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