Provider Demographics
NPI:1225218563
Name:LIVING ESSENCE PHYSICAL THERAPY & HERBAL PHARMACY, LLC
Entity Type:Organization
Organization Name:LIVING ESSENCE PHYSICAL THERAPY & HERBAL PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRACTIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:LEE IALONGO
Authorized Official - Last Name:GILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:401-954-1807
Mailing Address - Street 1:69 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3904
Mailing Address - Country:US
Mailing Address - Phone:401-954-1807
Mailing Address - Fax:401-295-5002
Practice Address - Street 1:38 BROWN ST
Practice Address - Street 2:2ND FLOOR, FRONT
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5039
Practice Address - Country:US
Practice Address - Phone:401-954-1807
Practice Address - Fax:401-295-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty