Provider Demographics
NPI:1528373685
Name:VIGNEAULT, MARTHA M (PT, DPT, MS)
Entity type:Individual
Prefix:PROF
First Name:MARTHA
Middle Name:M
Last Name:VIGNEAULT
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2717
Mailing Address - Country:US
Mailing Address - Phone:401-348-8112
Mailing Address - Fax:401-348-7009
Practice Address - Street 1:85 BEACH ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2717
Practice Address - Country:US
Practice Address - Phone:401-348-8112
Practice Address - Fax:401-348-7009
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist