MEDICARE: NORTHERN RI PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT01833	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75277	OTHER	RI	RI BLUE CROSS
2	402381	OTHER		RI BLUE CHIP
3	411376	OTHER		RI BLUE CHIP
4	411376	OTHER	RI	RI BLUE CHIP
5	640014E	OTHER		UNITED HEALTH NE
6	402508	OTHER		RI BLUE CHIP
7	410188	OTHER		RI BLUE CHIP
8	402512	OTHER		RI BLUE CHIP

General Provider Information

NPI Number	:	1033166657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN RI PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	1 GARNETT LN
Second Line	:	SUITE 3
City	:	GREENVILLE
State	:	RI
Zip	:	02828-1414
Country	:	US
Telephone Number	:	401-949-0380
Fax Number	:	401-949-5581

Provider Business Practice Location Address
First Line	:	1 GARNETT LN
Second Line	:	SUITE 3
City	:	GREENVILLE
State	:	RI
Zip	:	02828-1414
Country	:	US
Telephone Number	:	401-949-0380
Fax Number	:	401-949-5581

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. THOMAS J DUBUQUE JR.
Credential	:	MSPT
Telephone Number	:	401-949-0380

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1841266954 — DR. SCOTT B. KLIMAJ D.M.D.
Practice Location Address:

1 GARNETT LN , SUITE 8
GREENVILLE, RI
02828-1414

Practice Phone: 401-949-3200
Practice Fax: 401-949-5213

1700824414 — MS. AMANDA KEEGAN PT
Practice Location Address:

ONE GARNETT LANE , NORTHERN RI PHYSICAL THERAPY
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1023058997 — MS. ANDREA ROSS PT
Practice Location Address:

ONE GARNETT LANE , NORTHERN RI PHYSICAL THERAPY
GREENVILLE, RI
02828-1414

Practice Phone: 401-949-0380
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1255377628 — MS. LAURA JEAN YOUNG PT MSPT
Practice Location Address:

1 GARNETT LN , NORTHERN RI PHYSICAL THERAPY
GREENVILLE, RI
02828-1414

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Practice Fax: 401-949-5581

1801823042 — MR. MICHAEL G HALEY PHYSICAL THERPIST MS
Practice Location Address:

ONE GARNETT LANE , NORTHERN RI PHYSICAL THERAPY STE 3
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1396853313 — SCOTT B. KLIMAJ, DMD
Practice Location Address:

1 GARNETT LN , SUITE 8
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02828-1414

Practice Phone: 401-949-3200
Practice Fax: 401-949-5213

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