1912099938 NPI number — OLYMPIC PHYSICAL THERAPY & SPORTS MEDICINE INC.

Table of content: PATRICIA EUGENIA MERA VELASCO (NPI 1396683009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912099938 NPI number — OLYMPIC PHYSICAL THERAPY & SPORTS MEDICINE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLYMPIC PHYSICAL THERAPY & SPORTS MEDICINE 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:
1912099938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
OLYMPIC PHYSICAL THERAPY
Provider Second Line Business Mailing Address:
1181 AQUIDNECK AVE
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-845-0840
Provider Business Mailing Address Fax Number:
401-845-0842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OLYMPIC PHYSICAL THERAPY
Provider Second Line Business Practice Location Address:
1181 AQUIDNECK AVE
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-845-0840
Provider Business Practice Location Address Fax Number:
401-845-0842
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
KIRSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL BILLING
Authorized Official Telephone Number:
401-845-0840

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT02061 , 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)





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