Provider Demographics
NPI:1578996971
Name:RAMOS JR, NICANDRO S (PT,)
Entity Type:Individual
Prefix:
First Name:NICANDRO
Middle Name:S
Last Name:RAMOS JR
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 1:76 GANO ST # 2
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3823
Mailing Address - Country:US
Mailing Address - Phone:917-328-6355
Mailing Address - Fax:
Practice Address - Street 1:193 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1460
Practice Address - Country:US
Practice Address - Phone:617-442-3462
Practice Address - Fax:617-445-7874
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT011942251G0304X, 2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology