Individual
KENNETH TETELBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-8661
Mailing address
9 CHESTNUT ST, NARRAGANSETT, RI 02882-3903
(401) 789-9184
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA00356
RI
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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