Provider Demographics
NPI:1013375377
Name:ENTWISTLE, ARTHUR IV (MED, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:
Last Name:ENTWISTLE
Suffix:IV
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 BOTKA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-3703
Mailing Address - Country:US
Mailing Address - Phone:401-556-4305
Mailing Address - Fax:
Practice Address - Street 1:530 IVES RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-4609
Practice Address - Country:US
Practice Address - Phone:401-884-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT002542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer