Provider Demographics
NPI:1588617609
Name:LEPRE PHYSICAL THERAPY OF NORTH PROVIDENCE, LLC
Entity type:Organization
Organization Name:LEPRE PHYSICAL THERAPY OF NORTH PROVIDENCE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-785-1016
Mailing Address - Street 1:PO BOX 20372
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-0944
Mailing Address - Country:US
Mailing Address - Phone:401-785-1016
Mailing Address - Fax:401-785-1018
Practice Address - Street 1:1525 SMITH ST
Practice Address - Street 2:UNIT #5
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2959
Practice Address - Country:US
Practice Address - Phone:401-785-3334
Practice Address - Fax:401-785-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI659004555Medicare ID - Type Unspecified