Provider Demographics
NPI:1023397908
Name:CHULA-MAGUIRE, KIMBERLEY ANNE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:CHULA-MAGUIRE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 WAMPANOAG TRAIL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1038
Mailing Address - Country:US
Mailing Address - Phone:401-433-4049
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:41 SANDERSON ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2611
Practice Address - Country:US
Practice Address - Phone:401-475-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02404225100000X
PT02404225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist