Provider Demographics
NPI:1255392338
Name:MEDEIROS, KEVIN FRANCIS (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:FRANCIS
Last Name:MEDEIROS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 AIMES WAY
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-1259
Mailing Address - Country:US
Mailing Address - Phone:508-636-9060
Mailing Address - Fax:
Practice Address - Street 1:203 CONCORD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3477
Practice Address - Country:US
Practice Address - Phone:401-722-8880
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT007422251X0800X
MA70042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic