Healthcare Provider Details

I. General information

NPI: 1255531513
Provider Name (Legal Business Name): UNIVERSITY REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PARKWAY BUILDING 12
EAST PROVIDENCE RI
02914
US

IV. Provider business mailing address

450 VETERANS MEMORIAL PARKWAY BUILDING 12
EAST PROVIDENCE RI
02914
US

V. Phone/Fax

Practice location:
  • Phone: 401-435-2288
  • Fax: 401-435-2282
Mailing address:
  • Phone: 401-435-2288
  • Fax: 401-435-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDO00614
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT01685
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD06916
License Number StateRI

VIII. Authorized Official

Name: DR. JOHN R PARZIALE
Title or Position: PHYSIATRIST IN CHIEF
Credential: MD
Phone: 401-435-2288