Basic Information
| Provider Information | |||||||||
| NPI: | 1043358187 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON COUNTY PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64 | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028980064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015394600 | ||||||||
| FaxNumber: | 4015394600 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 STILSON RD | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028980064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015394600 | ||||||||
| FaxNumber: | 4015394600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PLUNKETT | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | PT | ||||||||
| AuthorizedOfficialTelephone: | 4015394600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PT711 | RI | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 25589 1 | 01 | RI | BLUE CROSS BLUE SHIELD | OTHER | 640085 | 01 | RI | UNITED HEALTH CARE | OTHER | 400873 | 01 | RI | BLUE CHIP | OTHER |