Provider Demographics
NPI:1073954483
Name:SIMOLI, ANNMARIE (LMT, BCTMB)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:SIMOLI
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WATERMAN STREET
Mailing Address - Street 2:AT THE THERAPY COLLABORATIVE
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2139
Mailing Address - Country:US
Mailing Address - Phone:401-499-2170
Mailing Address - Fax:
Practice Address - Street 1:1395 ATWOOD AVE
Practice Address - Street 2:SUITE 108A
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4929
Practice Address - Country:US
Practice Address - Phone:401-499-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-14
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT00404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist