Healthcare Provider Details

I. General information

NPI: 1407859515
Provider Name (Legal Business Name): MATTHEW ROBERT CARL M.S.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 NOOSENECK HILL RD UNIT 3
WEST GREENWICH RI
02817-1568
US

IV. Provider business mailing address

45 NOOSENECK HILL RD UNIT 12
WEST GREENWICH RI
02817-1564
US

V. Phone/Fax

Practice location:
  • Phone: 401-385-9530
  • Fax: 401-385-9532
Mailing address:
  • Phone: 401-385-9530
  • Fax: 401-385-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16252
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT01649
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008064
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: