Provider Demographics
NPI:1992852073
Name:OCEAN STATE PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:OCEAN STATE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:FRAUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:401-737-3934
Mailing Address - Street 1:400 BALD HILL RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1617
Mailing Address - Country:US
Mailing Address - Phone:401-737-3934
Mailing Address - Fax:401-737-1276
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:SUITE 502
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-737-3934
Practice Address - Fax:401-737-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT000654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI25567-7OtherBCBS PROVIDER NUMBER
RI25567-7OtherBCBS PROVIDER NUMBER