Provider Demographics
NPI:1275543753
Name:PADUANO, ROBERT ANTHONY (MSPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:PADUANO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 DAWES AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7353
Mailing Address - Country:US
Mailing Address - Phone:413-443-4246
Mailing Address - Fax:413-443-0737
Practice Address - Street 1:290 1ST ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4751
Practice Address - Country:US
Practice Address - Phone:413-443-4246
Practice Address - Fax:413-443-0737
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300331Medicaid
MAY67196OtherBC/BS
MAY68003Medicare ID - Type Unspecified