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Organization
SILVER FERN PRACTICE, LLC
Active
Organization
SILVER FERN PRACTICE, LLC
Active
Other names
Performance Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY TRASKAUSKAS (CREDENTIALING SPECIALIST)
(401) 433-4172
Entity
Organization
Contact information
Practice address
1235 WAMPANOAG TRL, RIVERSIDE, RI 02915-1231
(401) 433-4049
(401) 270-0118
Mailing address
4 RICHMOND SQ, SUITE 200, PROVIDENCE, RI 02906-5117
(401) 433-4172
(401) 433-0612
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
10/17/2016
Last updated
03/28/2017
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