Provider Demographics
NPI:1255664181
Name:MARIORENZI, MARIA LEE (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LEE
Last Name:MARIORENZI
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 1:725 RESERVOIR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4448
Mailing Address - Country:US
Mailing Address - Phone:401-944-3800
Mailing Address - Fax:401-944-1342
Practice Address - Street 1:725 RESERVOIR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4448
Practice Address - Country:US
Practice Address - Phone:401-944-3800
Practice Address - Fax:401-943-3129
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT10402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPT1040OtherSTATE LICENSE NUMBER