Individual
AL FANTASIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RRT-NPS
Contact information
Practice address
27 PARK ST, HYANNIS, MA 02601-5230
(508) 862-5000
Mailing address
27 PARK ST, HYANNIS, MA 02601-5230
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
RT2863
MA
2279C0205X
Critical Care Registered Respiratory Therapist
RT2863
—
2279E0002X
Emergency Care Registered Respiratory Therapist
RT2863
MA
2279P3900X
Neonatal/Pediatric Registered Respiratory Therapist
RT2863
—
Other
Enumeration date
04/29/2020
Last updated
04/29/2020
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