Provider Demographics
NPI:1609862788
Name:PATRICK, CARRIE O (MSPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:O
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CENTERVILLE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4394
Mailing Address - Country:US
Mailing Address - Phone:401-732-8200
Mailing Address - Fax:401-732-8230
Practice Address - Street 1:227 CENTERVILLE RD FL 2
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4394
Practice Address - Country:US
Practice Address - Phone:401-732-8200
Practice Address - Fax:401-732-8230
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI238027OtherBLUE CROSS PROVIDER NUMBE
RI238027OtherBLUE CROSS PROVIDER NUMBE