Provider Demographics
NPI:1881983138
Name:DELSESTO, TRACIE (PT, MBA)
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:
Last Name:DELSESTO
Suffix:
Gender:F
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 RESERVOIR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4418
Mailing Address - Country:US
Mailing Address - Phone:401-228-3939
Mailing Address - Fax:401-383-3043
Practice Address - Street 1:940 RESERVOIR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4418
Practice Address - Country:US
Practice Address - Phone:401-228-3939
Practice Address - Fax:401-383-3043
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist