Provider Demographics
NPI:1801228861
Name:GOULART, NADJA C (PT)
Entity Type:Individual
Prefix:
First Name:NADJA
Middle Name:C
Last Name:GOULART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NADJA
Other - Middle Name:C
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4 RICHMOND SQ
Mailing Address - Street 2:STE 200
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-946-4250
Mailing Address - Fax:401-275-5645
Practice Address - Street 1:1401 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4058
Practice Address - Country:US
Practice Address - Phone:401-726-7100
Practice Address - Fax:401-433-0612
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist