Individual
STEVEN A MIGNACCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
697 WILLETT AVE, RIVERSIDE, RI 02915-2642
(401) 228-7678
(401) 228-7681
Mailing address
PO BOX 20555, CRANSTON, RI 02920-0946
(401) 228-7678
(401) 228-7681
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT01117
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015873
MEDICARE PTAN
RI
01
—
PT01117
STATE LICENSE NUMBER
RI
Enumeration date
02/08/2007
Last updated
12/14/2012
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