Healthcare Provider Details

I. General information

NPI: 1790074821
Provider Name (Legal Business Name): STEVEN MATTHEW BROOKS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ROLFE SQ
CRANSTON RI
02910-2802
US

IV. Provider business mailing address

30 ROLFE SQ
CRANSTON RI
02910-2802
US

V. Phone/Fax

Practice location:
  • Phone: 401-725-8400
  • Fax: 401-725-8402
Mailing address:
  • Phone: 401-725-8400
  • Fax: 401-725-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT01523
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: