Provider Demographics
NPI:1952313728
Name:DUBUQUE, THOMAS J JR (PT MSPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:DUBUQUE
Suffix:JR
Gender:M
Credentials:PT MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DUDLEY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3236
Mailing Address - Country:US
Mailing Address - Phone:401-330-1428
Mailing Address - Fax:401-330-1447
Practice Address - Street 1:1 KETTLE POINT AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5375
Practice Address - Country:US
Practice Address - Phone:401-330-1428
Practice Address - Fax:401-330-1447
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
640014EOtherUNITED HEALTH NEW ENGLAND
RI75277OtherRI BLUE CROSS
RI411376OtherRI BLUE CHIP
659067527Medicare ID - Type Unspecified
RI75277OtherRI BLUE CROSS