NPI 1164907804

Interventional and Functional Pain Center

Organisation Physical Medicine & Rehabilitation Physician Cranston, RI

Practice location

Address: 1150 Reservoir Ave STE 200, Cranston, RI 02920-6043
Phone: (401) 648-6100

Authorised official

Name: Juan Carlos Mirt
Title: Office Manager
Phone: (401) 648-6100

Registered specialties (2)

Physical Medicine & Rehabilitation Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208100000X

Other Physical Medicine & Rehabilitation providers in Rhode Island →

Physical Therapy Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QP2000X

Other Clinic/Center providers in Rhode Island →

Registry record

NPI: 1164907804
Entity type: Organization
NPI issued: 28 Sep 2018
Record last updated: 22 Jan 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.