Provider Demographics
NPI:1770197782
Name:SHIEL-L'ESPERANCE, MARY (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SHIEL-L'ESPERANCE
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 1:904 LAPHAM FARM RD
Mailing Address - Street 2:
Mailing Address - City:MAPLEVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02839-1229
Mailing Address - Country:US
Mailing Address - Phone:401-636-2142
Mailing Address - Fax:
Practice Address - Street 1:11 KNIGHT ST BLDG F22
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1281
Practice Address - Country:US
Practice Address - Phone:401-231-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist