| Organization Name: | PARK SQUARE PHYSICAL THERAPY |
| NPI Number: | 1780971176 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RUSSELL NORMAN THIVIERGE (OWNER) |
| Mailing Address: | 1416 Park Ave Woonsocket |
| State: | RI US |
| Postal Code: | 028956557 |
| Phone Number: | 4013238682 |
| Fax Number: | 4017650123 |
| NPI Enumeration Date: | 07/06/2011 |
| NPI Last Update Date: | 08/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |