Provider Demographics
NPI:1407873078
Name:DEORSEY, JOSEPH W (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:DEORSEY
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 1:2 DUDLEY ST
Mailing Address - Street 2:STE 200
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3236
Mailing Address - Country:US
Mailing Address - Phone:401-884-1177
Mailing Address - Fax:
Practice Address - Street 1:1598 S COUNTY TRL STE 100
Practice Address - Street 2:
Practice Address - City:E GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1627
Practice Address - Country:US
Practice Address - Phone:401-884-1177
Practice Address - Fax:401-884-8697
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411169OtherBLUE CHIP