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General NPI Number Information
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NPI Number | 1205894532
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Entity Type | Organization
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Legal Business Name | MATRIX SPORTS MEDICINE & PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 233 EDDIE DOWLING HWY
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City | NORTH SMITHFIELD
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State | RI
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Zip | 02896-8213
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Country | US
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Telephone | 401-474-1293
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Fax |
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Provider Business Mailing Address
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Address Line | 233 EDDIE DOWLING HWY
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City | NORTH SMITHFIELD
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State | RI
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Zip | 02896-8213
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Country | US
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Telephone | 401-474-1293
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICAL THERAPIST
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Name | VICTORIA KENT HUESTON
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Credential | MSPT
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Telephone | 401-474-1293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT01736
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License Number State | RI
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