Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 02580 | RI |
N | 2251S0007X | Physical Therapist - Sports | 5367 | CO |
NPI | 1144279308 |
---|---|
Provider Name | Mr. Robert William Wishtischin |
First Address | Cranston, RI 02910-4430 |
Second Address | Cranston, RI 02910-4430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 18/06/2013 |