Provider Demographics
NPI:1194851501
Name:PETRANGELO, AMY D (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:PETRANGELO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 S POND DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-7971
Mailing Address - Country:US
Mailing Address - Phone:401-615-2501
Mailing Address - Fax:401-397-8398
Practice Address - Street 1:2075 NOOSENECK HILL RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6709
Practice Address - Country:US
Practice Address - Phone:401-397-8399
Practice Address - Fax:401-397-8398
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIP35351Medicare UPIN