Provider Demographics
NPI:1659545572
Name:CRELLIN THERAPY SERVICES
Entity Type:Organization
Organization Name:CRELLIN THERAPY SERVICES
Other - Org Name:COWESETT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CRELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, RPT
Authorized Official - Phone:401-821-6091
Mailing Address - Street 1:328 COWESETT AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2248
Mailing Address - Country:US
Mailing Address - Phone:401-821-6091
Mailing Address - Fax:401-821-1880
Practice Address - Street 1:328 COWESETT AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2248
Practice Address - Country:US
Practice Address - Phone:401-821-6091
Practice Address - Fax:401-821-1880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREW T. CRELLIN, D.C.,R.P.T.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00905261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIT92415Medicare UPIN