Provider Demographics
NPI:1104957620
Name:FIORE, RUSSELL D (ATC)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:D
Last Name:FIORE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RED CHIMNEY DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4610
Mailing Address - Country:US
Mailing Address - Phone:401-723-1055
Mailing Address - Fax:401-863-1156
Practice Address - Street 1:BROWN UNIVERSITY
Practice Address - Street 2:235 HOPE ST
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02912-0001
Practice Address - Country:US
Practice Address - Phone:401-863-3851
Practice Address - Fax:401-863-1156
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT000142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer