Provider Demographics
NPI:1689743304
Name:FENTON, BARBARA ANN (MSPT, CSCS)
Entity Type:Individual
Prefix:
First Name:BARBARA ANN
Middle Name:
Last Name:FENTON
Suffix:
Gender:F
Credentials:MSPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5354
Mailing Address - Country:US
Mailing Address - Phone:401-846-7938
Mailing Address - Fax:
Practice Address - Street 1:1160 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3265
Practice Address - Country:US
Practice Address - Phone:401-941-9111
Practice Address - Fax:401-941-5906
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist