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NPI Code Detail

MEDICARE: NADJA C GOULART PT

MEDICARE: NADJA C GOULART PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT02599RI

General Provider Information

NPI Number : 1801228861
Entity Type Code : Individual
Provider Name (Legal Business Name) : NADJA C GOULART PT
Provider Business Mailing Address
First Line : 4 RICHMOND SQ
Second Line : STE 200
City : PROVIDENCE
State : RI
Zip : 02906-5117
Country : US
Telephone Number : 401-946-4250
Fax Number : 401-275-5645
Provider Business Practice Location Address
First Line : 1401 DOUGLAS AVE
Second Line :
City : NORTH PROVIDENCE
State : RI
Zip : 02904-4058
Country : US
Telephone Number : 401-726-7100
Fax Number : 401-433-0612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2013
Last Update Date : 07/21/2022

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Directions to “ NADJA C GOULART PT” Practice Location

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