Provider Demographics
NPI:1538116009
Name:SOUSA, KARA LYNN (MS,PT)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:LYNN
Last Name:SOUSA
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5305
Mailing Address - Country:US
Mailing Address - Phone:401-726-7100
Mailing Address - Fax:401-722-9386
Practice Address - Street 1:1525 WAMPANOAG TRL
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-1038
Practice Address - Country:US
Practice Address - Phone:401-433-4049
Practice Address - Fax:401-433-0612
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29836-6OtherBLUE CROSS/BLUE SHIELD
RI409847OtherBLUE CHIP