Provider Demographics
NPI:1487809323
Name:DANSEREAU, DAVID P (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:DANSEREAU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 MENDON RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4392
Mailing Address - Country:US
Mailing Address - Phone:401-241-2803
Mailing Address - Fax:
Practice Address - Street 1:1764 MENDON RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4392
Practice Address - Country:US
Practice Address - Phone:401-241-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPT01557OtherSTATE LICENSE
MA15260OtherMASS LICENSE #
RIPT01557OtherSTATE LICENSE