Provider Demographics
NPI:1285685099
Name:MAURICIO, STEVEN N (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:N
Last Name:MAURICIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 CRANDALL ROAD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878
Mailing Address - Country:US
Mailing Address - Phone:401-692-7285
Mailing Address - Fax:
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:BLDG
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-435-2288
Practice Address - Fax:401-435-2282
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6590042151OtherMEDICARE
RI409024OtherBLUECIP RI IND. ID #
RI29621OtherBLUE CROSS
RI409024OtherBLUECIP RI IND. ID #
RI29621OtherBLUE CROSS