Healthcare Provider Details

I. General information

NPI: 1366407306
Provider Name (Legal Business Name): FLEXIBLE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N MAIN ST SUITE 1B
PROVIDENCE RI
02904-5700
US

IV. Provider business mailing address

845 N MAIN ST SUITE 1B
PROVIDENCE RI
02904-5700
US

V. Phone/Fax

Practice location:
  • Phone: 401-270-1905
  • Fax: 401-270-5658
Mailing address:
  • Phone: 401-270-1905
  • Fax: 401-270-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberPT01811
License Number StateRI

VIII. Authorized Official

Name: MRS. LISA M PICKETT
Title or Position: OWNER/PRESIDENT
Credential: PT
Phone: 401-270-1905