Provider Demographics
NPI:1235495243
Name:SACCO, KATHRYN MARIE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:SACCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RICHMOND SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-433-4172
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:12 STILSON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:RI
Practice Address - Zip Code:02898-1026
Practice Address - Country:US
Practice Address - Phone:401-726-7100
Practice Address - Fax:401-722-9386
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009130225100000X
RIAT002722255A2300X
RIPT02391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer