Organization
LIBERTY PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK E WURSTER MSPT (VP TREASURER)
(401) 722-0012
Entity
Organization
Contact information
Practice address
872 SMITHFIELD AVE, LINCOLN, RI 02865
(401) 722-0012
(401) 722-0056
Mailing address
872 SMITHFIELD AVE, LINCOLN, RI 02865
(401) 722-0012
(401) 722-0056
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6400365
UHP
—
Enumeration date
07/30/2006
Last updated
11/14/2007
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