OrganizationActive
Interventional and Functional Pain Center
NPI 1164907804 · Physical Medicine & Rehabilitation Physician · Cranston, RI
Provider details
- NPI number
- 1164907804
- Entity type
- Organization
- Primary specialty
- Physical Medicine & Rehabilitation PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Juan Carlos Mirt, Office Manager
Practice location
1150 Reservoir Ave Ste 200
Cranston, RI 02920-6043
Phone: (401) 648-6100
Mailing address
1150 Reservoir Ave Ste 200
Cranston, RI 02920-6043
Registry dates
- Enumerated
- 2018-09-28
- Last updated
- 2025-01-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.