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General NPI Number Information
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NPI Number | 1720149768
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Entity Type | Organization
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Legal Business Name | COVENTRY PHYSICAL THERAPY & SPORTS MEDICINE, INC.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2075 NOOSENECK HILL RD
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City | COVENTRY
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State | RI
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Zip | 02816-6709
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Country | US
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Telephone | 401-397-8399
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Fax | 401-397-8398
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Provider Business Mailing Address
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Address Line | 2075 NOOSENECK HILL RD
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City | COVENTRY
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State | RI
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Zip | 02816-6709
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Country | US
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Telephone | 401-397-8399
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Fax | 401-397-8398
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARYBETH MCGOVERN
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Credential | MS, PT
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Telephone | 401-397-8399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | RI943
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License Number State | RI
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