Provider Demographics
NPI:1669683603
Name:ROSENBLUM, ALISSON (PT)
Entity Type:Individual
Prefix:
First Name:ALISSON
Middle Name:
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-8502
Mailing Address - Country:US
Mailing Address - Phone:401-615-0304
Mailing Address - Fax:
Practice Address - Street 1:650 TEN ROD RD
Practice Address - Street 2:LAFAYETTE MILL COMPLEX, #10
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4238
Practice Address - Country:US
Practice Address - Phone:401-787-3476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist