Provider Demographics
NPI:1215077748
Name:SANTOMASSIMO, MARIO D III (PT)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:D
Last Name:SANTOMASSIMO
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SOCKANOSSET CROSS RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5536
Mailing Address - Country:US
Mailing Address - Phone:401-944-7574
Mailing Address - Fax:401-944-7602
Practice Address - Street 1:51 SOCKANOSSET CROSS RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5536
Practice Address - Country:US
Practice Address - Phone:401-944-7574
Practice Address - Fax:401-944-7602
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPT00783OtherSTATE LICENSE NUMBER
RIPT00783OtherSTATE LICENSE NUMBER