Individual provider Active NPI

Marina Reis Marinho Nogueira, DPT

  • Physical Therapist
  • Riverside, RI
National Provider Identifier
1265031264
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT03295 Issued in RI
Practice address
375 Wampanoag TRL Ste 403
Riverside, RI 02915-2237
Phone
(401) 270-8770
Fax
(401) 270-8772
NPI assigned
Oct 21, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT03295 RI Primary

Addresses

Primary practice location

375 Wampanoag TRL Ste 403
Riverside, RI 02915-2237

Mailing address

4 Richmond SQ Ste 200
Providence, RI 02906-5117
Phone (401) 433-4172

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201102000361 RI Practitioner - Physical Therapist in Private Practice 0143630277 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT03295RIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Silver Fern Practice, LLC Physical Therapist CurrentSince Aug 14, 2020 Accepting new patients
Silver Fern Practice, LLC Physical Therapist CurrentSince Aug 14, 2020 Accepting new patients
Pelvic Health & Wellness LLC Physical Therapist CurrentSince Jul 12, 2022 Accepting new patients

Locations

4 Richmond Sq
Ste 200
Providence, RI 02906

375 Wampanoag Trl
Ste 403
Riverside, RI 02915
Phone (401) 270-8770

41 Sanderson Rd
Ste 101
Smithfield, RI 02917
Phone (401) 349-4540

469 Centerville Rd
Ste 101
Warwick, RI 02886
Phone (401) 320-7101

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1265031264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 RICHMOND SQ STE 200",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065117",
            "telephone_number": "401-433-4172",
            "fax_number": "401-433-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 WAMPANOAG TRL STE 403",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029152237",
            "telephone_number": "401-270-8770",
            "fax_number": "401-270-8772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REIS MARINHO NOGUEIRA",
        "first_name": "MARINA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-21",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "RI",
            "license": "PT03295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.