Provider Demographics
NPI:1205894532
Name:MATRIX SPORTS MEDICINE & PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:MATRIX SPORTS MEDICINE & PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:HUESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:401-474-1293
Mailing Address - Street 1:233 EDDIE DOWLING HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-8213
Mailing Address - Country:US
Mailing Address - Phone:401-474-1293
Mailing Address - Fax:
Practice Address - Street 1:233 EDDIE DOWLING HWY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-8213
Practice Address - Country:US
Practice Address - Phone:401-474-1293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty