Healthcare Provider Details

I. General information

NPI: 1174537443
Provider Name (Legal Business Name): COMPREHENSIVE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 VICTORY HIGHWAY
SLATERSVILLE RI
02876-0656
US

IV. Provider business mailing address

PO BOX 656
SLATERSVILLE RI
02876-0656
US

V. Phone/Fax

Practice location:
  • Phone: 401-762-5390
  • Fax: 401-762-5392
Mailing address:
  • Phone: 401-762-5390
  • Fax: 401-762-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS MAEGEN LEIGH PHELAN
Title or Position: MANAGER
Credential:
Phone: 401-762-5390