Provider Demographics
NPI:1033166657
Name:NORTHERN RI PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NORTHERN RI PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUBUQUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSPT
Authorized Official - Phone:401-949-0380
Mailing Address - Street 1:1 GARNETT LN
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1414
Mailing Address - Country:US
Mailing Address - Phone:401-949-0380
Mailing Address - Fax:401-949-5581
Practice Address - Street 1:1 GARNETT LN
Practice Address - Street 2:SUITE 3
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1414
Practice Address - Country:US
Practice Address - Phone:401-949-0380
Practice Address - Fax:401-949-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI75277OtherRI BLUE CROSS
402381OtherRI BLUE CHIP
411376OtherRI BLUE CHIP
RI411376OtherRI BLUE CHIP
640014EOtherUNITED HEALTH NE
402508OtherRI BLUE CHIP
410188OtherRI BLUE CHIP
402512OtherRI BLUE CHIP