Provider Demographics
NPI:1154368314
Name:SLESIONA, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SLESIONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-1824
Mailing Address - Country:US
Mailing Address - Phone:401-315-2995
Mailing Address - Fax:401-315-2996
Practice Address - Street 1:19 GROVE AVE
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-1824
Practice Address - Country:US
Practice Address - Phone:401-315-2995
Practice Address - Fax:401-315-2996
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01004225100000X
CT006650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI709003969Medicare PIN
RI007057636Medicare PIN
RI6656630001Medicare NSC
CTC03243Medicare ID - Type UnspecifiedGROUP