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General NPI Number Information
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NPI Number | 1659883742
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Entity Type | Organization
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Legal Business Name | ACADEMY PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 10/29/2017
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Last Update Date | 10/29/2017
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Provider Practice Location Address
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Address Line | 667 ACADEMY AVE
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City | PROVIDENCE
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State | RI
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Zip | 02908-2105
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Country | US
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Telephone | 401-418-1835
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Fax |
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Provider Business Mailing Address
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Address Line | 667 ACADEMY AVE
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City | PROVIDENCE
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State | RI
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Zip | 02908-2105
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | DR. NICHOLAS BRUNO
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Credential | DPT
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Telephone | 401-418-1835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT02713
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License Number State | RI
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