Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 225100000X | Physical Therapist | | 5669 | MASSACHUSETTS | No |
| 2 | 225100000X | Physical Therapist | | PT00646 | RHODE ISLAND | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | PT0182 | OTHER | MASSACHUSETTS | MEDICARE GROUP # OT SERV |
| 2 | AA46223 | OTHER | RHODE ISLAND | HPHC RI PROV ID# |
| 3 | PT0067 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MEDICARE GROUP # |
| 4 | 70151140002 | OTHER | | CIGNA NON-PAR |
| 5 | 605716 | OTHER | MASSACHUSETTS | HPHC MA PROV ID# |
| 6 | 1454-35-0001 | OTHER | RHODE ISLAND | DMERC ID # |
| 7 | Y65737 | OTHER | MASSACHUSETTS | MA BCBS PROV ID # |
| 8 | 401280 | OTHER | RHODE ISLAND | RI BLUECHIP PROV # |
| 9 | 659007536 | MEDICARE ID-TYPE UNSPECIFIED | RHODE ISLAND | MEDICARE GROUP # |
| 10 | 5712442 | OTHER | MASSACHUSETTS | AETNA INDIVIDUAL # |
| 11 | PT00646 | OTHER | RHODE ISLAND | PT LICENSE # STATE OF RI |
| 12 | 5669 | OTHER | MASSACHUSETTS | PT LICENSE STATE OF MA |
| 13 | 7536 | OTHER | RHODE ISLAND | RI BCBS PROV # |
| 14 | CA-6711 | MEDICARE ID-TYPE UNSPECIFIED | RHODE ISLAND | RAILROAD MEDICARE GRP # |
| 15 | 2015585 | OTHER | RHODE ISLAND | AETNA PROV ID# |
| 16 | 007002734 | MEDICARE ID-TYPE UNSPECIFIED | RHODE ISLAND | INDIVIDUAL PROVIDER # |
| 17 | 1454350001 | MEDICARE NSC | MASSACHUSETTS | |
| 18 | 19016 | OTHER | | NEIGHBORHOOD HEALTH PLAN |
| 19 | Y68169 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | INDIVIDUAL PROVIDER # |
| 20 | 1454350001 | MEDICARE NSC | RHODE ISLAND | |