MEDICARE: MR. SAMUEL PATERSON 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	PTA00699	RI

General Provider Information

NPI Number	:	1720897655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL PATERSON PTA

Provider Business Mailing Address
First Line	:	98 ROBINSON ST
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-3526
Country	:	US
Telephone Number	:	401-595-7097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SAINT ELIZABETH WAY
Second Line	:
City	:	EAST GREENWICH
State	:	RI
Zip	:	02818-2163
Country	:	US
Telephone Number	:	401-595-7097
Fax Number	:

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

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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