| NPI | LastName | FirstName | MidName | Organization | Mailing Address | City | State | Zip |
| 1861592156 | CARAYANNOPOULOS | ALEXIOS | GEORGE | 117 ELLENFIELD STREET | PROVIDENCE | RI | 029054513 | |
| 1235418369 | KIM | SU GYM | 117 ELLENFIELD ST | PROVIDENCE | RI | 029054513 | ||
| 1003012014 | SCARFO | KEITH-AUSTIN | 117 ELLENFIELD ST | PROVIDENCE | RI | 029054513 |