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
—
—
Other
Enumeration date
10/17/2016
Last updated
03/28/2017
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