Healthcare Provider Details

I. General information

NPI: 1386654705
Provider Name (Legal Business Name): AMY L. VINCENT MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SALT POND RD STE D4
WAKEFIELD RI
02879-4334
US

IV. Provider business mailing address

24 SALT POND RD STE D4
WAKEFIELD RI
02879-4334
US

V. Phone/Fax

Practice location:
  • Phone: 401-667-4965
  • Fax: 401-667-7243
Mailing address:
  • Phone: 401-667-4965
  • Fax: 401-667-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT02055
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT02055
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: