Provider Demographics
NPI:1073726733
Name:PROVIDENCE PHYSICAL THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PROVIDENCE PHYSICAL THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPT, PHD
Authorized Official - Phone:401-521-2214
Mailing Address - Street 1:655 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1444
Mailing Address - Country:US
Mailing Address - Phone:401-521-2214
Mailing Address - Fax:401-861-4047
Practice Address - Street 1:655 BROAD ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1444
Practice Address - Country:US
Practice Address - Phone:401-521-2214
Practice Address - Fax:401-861-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy