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1417228016
MATTHEW SHANE DONNELLY ST GERMAIN
WARWICK, RI
NPI
1417228016
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Former Name
MATTHEW SHANE DONNELLY
Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
172M00000X Mechanotherapist
(Licence: RI 705)
Enumeration Date
2012-01-13
Last Update Date
2023-11-07
Business Address
MATTHEW SHANE DONNELLY ST GERMAIN RN, LMT
422 POST RD SUITE G2
WARWICK, RI 02888-2802
Phone number: 401-467-9193
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Mailing Address
MATTHEW SHANE DONNELLY ST GERMAIN RN, LMT
144 WATERMAN ST STE 5
PROVIDENCE, RI 02906-2126
Phone number: 401-413-7525
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