Provider Demographics
NPI:1659645588
Name:BEYOND BASICS REHABILITATION, LLC
Entity Type:Organization
Organization Name:BEYOND BASICS REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELSESTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:401-228-3939
Mailing Address - Street 1:940 RESERVOIR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4418
Mailing Address - Country:US
Mailing Address - Phone:401-228-3939
Mailing Address - Fax:401-398-0998
Practice Address - Street 1:940 RESERVOIR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4418
Practice Address - Country:US
Practice Address - Phone:401-228-3939
Practice Address - Fax:401-398-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy