Individual
MR. PAUL MATTHEW LYDEARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1539 ATWOOD AVE, JOHNSTON, RI 02919-3262
(401) 351-0515
(401) 351-0530
Mailing address
PO BOX 20372, CRANSTON, RI 02920-0944
(401) 785-1016
(401) 785-1018
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT02022
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT02022
STATE LICENSE NUMBER
RI
Enumeration date
07/13/2007
Last updated
07/13/2007
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