Individual
MR. RAFAEL DAVID PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2871 POST RD, PREHAB SPORTS MEDICARE SERVICES INC., WARWICK, RI 02886-0076
(401) 463-3060
(401) 732-1045
Mailing address
2871 POST RD, WARWICK, RI 02886-3116
(401) 463-3060
(401) 732-1045
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA01130
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
402551
BLUE CROSS
RI
01
—
64-00223
UNITED HEALTH
RI
01
—
7542-8
BLUE CROSS
RI
Enumeration date
08/02/2017
Last updated
08/02/2017
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