Healthcare Provider Details

I. General information

NPI: 1306896311
Provider Name (Legal Business Name): RHODE ISLAND REHABILITATION INSTITUTE P.C,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 RESERVOIR AVE
CRANSTON RI
02910-4430
US

IV. Provider business mailing address

721 RESERVOIR AVE
CRANSTON RI
02910-4430
US

V. Phone/Fax

Practice location:
  • Phone: 401-946-4250
  • Fax: 401-942-3960
Mailing address:
  • Phone: 401-946-4250
  • Fax: 401-942-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. HENRY SISUN
Title or Position: PRESIDENT/CEO
Credential: MSPT
Phone: 401-946-4250