Individual
DIANE M MACKSOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
285 PROMENADE ST, PROVIDENCE, RI 02908-5794
(401) 459-4001
Mailing address
285 PROMENADE ST, PROVIDENCE, RI 02908-5794
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02331
RI
2251S0007X
Sports Physical Therapist
—
—
Other
Enumeration date
09/03/2010
Last updated
09/03/2010
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