Provider Demographics
NPI:1679189427
Name:DEREDITA, ELEANOR (DPT)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:DEREDITA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2784
Mailing Address - Country:US
Mailing Address - Phone:401-596-3593
Mailing Address - Fax:401-596-3789
Practice Address - Street 1:81 BEACH ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2784
Practice Address - Country:US
Practice Address - Phone:401-596-3593
Practice Address - Fax:401-596-3789
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT0285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist