1235422262 NPI number — ALL COAST PHYSICAL THERAPY, INC.

Table of content: (NPI 1235422262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235422262 NPI number — ALL COAST PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL COAST PHYSICAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235422262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 RICH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUMFORD
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02916-1831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-480-2572
Provider Business Mailing Address Fax Number:
401-383-9729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 PROSPECT ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-480-2572
Provider Business Practice Location Address Fax Number:
401-383-9729
Provider Enumeration Date:
05/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SILVA
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PHYSICAL THERAPIST/PRESIDENT
Authorized Official Telephone Number:
401-480-2572

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  PT02095 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT02095 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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