=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366598997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAULA SILVA, MSPT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 06/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 865 WATERMAN AVE
-----------------------------------------------------
City | EAST PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02914-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-438-0191
-----------------------------------------------------
Fax | 401-438-6181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 865 WATERMAN AVE
-----------------------------------------------------
City | EAST PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02914-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-438-0191
-----------------------------------------------------
Fax | 401-438-6181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. PAULA SILVA
-----------------------------------------------------
Credential | MSPT
-----------------------------------------------------
Telephone | 401-438-0191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------