Provider Demographics
NPI:1932230877
Name:DOLAN, ROBIN M (PT)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:M
Last Name:DOLAN
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 1:100 SMITHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3497
Mailing Address - Country:US
Mailing Address - Phone:401-725-9666
Mailing Address - Fax:401-722-5896
Practice Address - Street 1:100 SMITHFIELD AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3497
Practice Address - Country:US
Practice Address - Phone:401-725-9666
Practice Address - Fax:401-727-2750
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI402654OtherBLUE CROSS BS BLUE CHIP
RI402654OtherBLUE CROSS BS BLUE CHIP