Individual
MR. PETER J. STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
134 THURBERS AVE, PROVIDENCE, RI 02905-4754
(401) 331-1350
(401) 277-3366
Mailing address
PO BOX 6688, PROVIDENCE, RI 02940-6688
(401) 331-1350
(401) 277-3366
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT00331
RI
Other
Enumeration date
09/17/2012
Last updated
09/11/2013
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