Provider Demographics
NPI:1548383631
Name:PREHAB SPORTS MEDICINE SERVICES INC
Entity Type:Organization
Organization Name:PREHAB SPORTS MEDICINE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-463-3060
Mailing Address - Street 1:2871 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-3116
Mailing Address - Country:US
Mailing Address - Phone:401-463-3060
Mailing Address - Fax:401-732-1045
Practice Address - Street 1:2871 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3116
Practice Address - Country:US
Practice Address - Phone:401-463-3060
Practice Address - Fax:401-732-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6400223OtherUNITED HEALTH
RI75428OtherBLUE CROSS
RI75428OtherBLUE CROSS