Provider Demographics
NPI:1790708444
Name:DUMAS, KIM MARIE R (MPT)
Entity Type:Individual
Prefix:
First Name:KIM MARIE
Middle Name:R
Last Name:DUMAS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FIRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1725
Mailing Address - Country:US
Mailing Address - Phone:401-886-5581
Mailing Address - Fax:
Practice Address - Street 1:18 5TH AVE
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3108
Practice Address - Country:US
Practice Address - Phone:401-884-9541
Practice Address - Fax:401-884-9509
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411382OtherRI BLUE CHIP PIN
RI007056168Medicare PIN