Individual
LAURA DEGRANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 EDDY ST, PROVIDENCE, RI 02905-4739
(401) 533-9100
Mailing address
1000 EDDY ST, PROVIDENCE, RI 02905-4739
(401) 533-9100
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT02898
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0614
NEIGHBORHOOD HEALTH PLAN
RI
05
—
ES01788
—
RI
01
—
SB870
BLUE CROSS
RI
Enumeration date
07/17/2009
Last updated
04/08/2016
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