Provider Demographics
NPI:1912099938
Name:OLYMPIC PHYSICAL THERAPY & SPORTS MEDICINE INC.
Entity Type:Organization
Organization Name:OLYMPIC PHYSICAL THERAPY & SPORTS MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-845-0840
Mailing Address - Street 1:OLYMPIC PHYSICAL THERAPY
Mailing Address - Street 2:1181 AQUIDNECK AVE
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-845-0840
Mailing Address - Fax:401-845-0842
Practice Address - Street 1:OLYMPIC PHYSICAL THERAPY
Practice Address - Street 2:1181 AQUIDNECK AVE
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-845-0840
Practice Address - Fax:401-845-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI659094815Medicare ID - Type UnspecifiedMECICARE GROUP LEGACY NUM
659094815Medicare PIN