# PRIMAL PHYSICAL THERAPY & SPORTS MEDICINE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639706229
- **Authorized official:** TIMOTHY DAVID SWENSON DPT (PHYSICAL THERAPIST, OWNER)
- **Authorized official phone:** (508) 277-5233

## Contact information

- **Practice address:** 25 CORONADO RD, WARWICK, RI 02886-1404
- **Practice address phone:** (508) 277-5233
- **Mailing address:** 775 WILLIAMSBURG CIR, WARWICK, RI 02886-1741
- **Mailing address phone:** (508) 277-5233

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/24/2020
- **Last updated:** 03/24/2020