Provider Demographics
NPI:1891068904
Name:BERUBE HOLDINGS, LLC
Entity Type:Organization
Organization Name:BERUBE HOLDINGS, LLC
Other - Org Name:NORTHEAST PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BERUBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-692-6883
Mailing Address - Street 1:544 SEVEN MILE RD
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:RI
Mailing Address - Zip Code:02831-1849
Mailing Address - Country:US
Mailing Address - Phone:401-692-6883
Mailing Address - Fax:
Practice Address - Street 1:544 SEVEN MILE RD
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:RI
Practice Address - Zip Code:02831-1849
Practice Address - Country:US
Practice Address - Phone:401-692-6883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty