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Organization
INTERVENTIONAL AND FUNCTIONAL PAIN CENTER
Active
Organization
INTERVENTIONAL AND FUNCTIONAL PAIN CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN CARLOS MIRT (OFFICE MANAGER)
(401) 648-6100
Entity
Organization
Contact information
Practice address
1150 RESERVOIR AVE STE 200, CRANSTON, RI 02920-6043
(401) 648-6100
Mailing address
1150 RESERVOIR AVE STE 200, CRANSTON, RI 02920-6043
(401) 648-6100
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
NULL
Other
Enumeration date
09/28/2018
Last updated
01/22/2025
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