Provider Demographics
NPI:1164912564
Name:SMYRSKI, MARISSA (DPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SMYRSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 CENTERVILLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4376
Mailing Address - Country:US
Mailing Address - Phone:401-737-6011
Mailing Address - Fax:401-737-4811
Practice Address - Street 1:982 TIOGUE AVNEUE
Practice Address - Street 2:SUITE 202
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816
Practice Address - Country:US
Practice Address - Phone:401-615-3140
Practice Address - Fax:401-615-8611
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist