Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00127 | RI |
N | 2251G0304X | Physical Therapist - Geriatrics | PT00127 | RI |
N | 2251S0007X | Physical Therapist - Sports | PT00127 |
NPI | 1164843058 |
---|---|
Provider Name | Mr. Francis George |
First Address | Cumberland, RI 02864-3908 |
Second Address | Cumberland, RI 02864-3908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2013 |
Last Update Date | 19/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7564-2 | BLUE CROSS BLUE SHIELD OF RHODE ISLAND (01) | RI |