Provider Demographics
NPI:1881797934
Name:WHITCOMB, BRIAN W (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:W
Last Name:WHITCOMB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 CENTERVILLE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-737-4581
Mailing Address - Fax:401-737-6152
Practice Address - Street 1:535 CENTERVILLE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-737-4581
Practice Address - Fax:401-737-6152
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC27869-4OtherBC
RI411817OtherBLUE CHIP
RIS77129Medicare UPIN