Provider Demographics
NPI:1447019468
Name:SILVER FERN PRACTICE, LLC
Entity type:Organization
Organization Name:SILVER FERN PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MONIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-433-4172
Mailing Address - Street 1:4 RICHMOND SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-433-4172
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:115 NORWOOD PARK S
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4633
Practice Address - Country:US
Practice Address - Phone:401-726-7100
Practice Address - Fax:401-433-0612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVER FERN PRACTICE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-14
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty