Provider Demographics
NPI:1912151911
Name:SILVA, BRYAN C (MS,PT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:C
Last Name:SILVA
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 RICH ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1831
Mailing Address - Country:US
Mailing Address - Phone:401-475-5775
Mailing Address - Fax:401-475-5776
Practice Address - Street 1:545 PAWTUCKET AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6046
Practice Address - Country:US
Practice Address - Phone:401-475-5775
Practice Address - Fax:401-475-5776
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist