1225218563 NPI number — LIVING ESSENCE PHYSICAL THERAPY & HERBAL PHARMACY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225218563 NPI number — LIVING ESSENCE PHYSICAL THERAPY & HERBAL PHARMACY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIVING ESSENCE PHYSICAL THERAPY & HERBAL PHARMACY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225218563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 CHESTNUT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH KINGSTOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02852-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-954-1807
Provider Business Mailing Address Fax Number:
401-295-5002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 BROWN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR, FRONT
Provider Business Practice Location Address City Name:
NORTH KINGSTOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02852-5039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-954-1807
Provider Business Practice Location Address Fax Number:
401-295-5002
Provider Enumeration Date:
11/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILLETTE
Authorized Official First Name:
KERRI
Authorized Official Middle Name:
LEE IALONGO
Authorized Official Title or Position:
OWNER/ PRACTIONER
Authorized Official Telephone Number:
401-954-1807

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1253 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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