Provider Demographics
NPI:1841262854
Name:VIGEANT, ANDREA L (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:VIGEANT
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:PO BOX 20372
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-0944
Mailing Address - Country:US
Mailing Address - Phone:401-785-1016
Mailing Address - Fax:401-785-1018
Practice Address - Street 1:5805 POST RD
Practice Address - Street 2:UNIT 1
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2171
Practice Address - Country:US
Practice Address - Phone:401-884-9700
Practice Address - Fax:401-884-9703
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007166225100000X
RIPT02108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650000777Medicare ID - Type Unspecified