Provider Demographics
NPI:1366407306
Name:FLEXIBLE PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:FLEXIBLE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:401-270-1905
Mailing Address - Street 1:845 N MAIN ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5700
Mailing Address - Country:US
Mailing Address - Phone:401-270-1905
Mailing Address - Fax:401-270-5658
Practice Address - Street 1:845 N MAIN ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5700
Practice Address - Country:US
Practice Address - Phone:401-270-1905
Practice Address - Fax:401-270-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01811261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI=========OtherTAX ID NUMBER