Provider Demographics
NPI:1083216352
Name:MADDY'S MED-CLINICS LLC
Entity Type:Organization
Organization Name:MADDY'S MED-CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:TESTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-451-5635
Mailing Address - Street 1:1239 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7137
Mailing Address - Country:US
Mailing Address - Phone:401-451-5635
Mailing Address - Fax:401-451-5636
Practice Address - Street 1:1239 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7137
Practice Address - Country:US
Practice Address - Phone:401-451-5635
Practice Address - Fax:401-451-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty