1457477945 NPI number — SAKONNET PHYSICAL THERAPY, INC

Table of content: (NPI 1457477945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457477945 NPI number — SAKONNET PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAKONNET 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:
6
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:
1457477945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 SHOVE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIVERTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02878-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-624-4743
Provider Business Mailing Address Fax Number:
401-624-9152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 SHOVE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIVERTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02878-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-624-4743
Provider Business Practice Location Address Fax Number:
401-624-9152
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHAVES
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
BROOKE
Authorized Official Title or Position:
PHYSICAL THERAPIST PRESIDENT
Authorized Official Telephone Number:
401-624-4743

Provider Taxonomy Codes

  • Taxonomy code: 2081S0010X , with the licence number:  PT01579 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 407329 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 233358 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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