Provider Demographics
NPI:1346563467
Name:HUMPHREY-ARRUDA, LOUISE (LAT, ATC, LMT, BCMTB)
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:
Last Name:HUMPHREY-ARRUDA
Suffix:
Gender:F
Credentials:LAT, ATC, LMT, BCMTB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 OLD MAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-4845
Mailing Address - Country:US
Mailing Address - Phone:401-486-7379
Mailing Address - Fax:
Practice Address - Street 1:300 INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-3133
Practice Address - Country:US
Practice Address - Phone:401-486-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT002832255A2300X
RIMT00968225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer