Provider Demographics
NPI:1144345323
Name:SILVA, CARLA BLACKWELL (PT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:BLACKWELL
Last Name:SILVA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 PAWTUCKET AVE
Mailing Address - Street 2:FOUNDATION PERFORMANCE, MAILBOX 402
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6046
Mailing Address - Country:US
Mailing Address - Phone:401-475-5775
Mailing Address - Fax:
Practice Address - Street 1:545 PAWTUCKET AVE
Practice Address - Street 2:FOUNDATION PERFORMANCE, MAILBOX 402
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6046
Practice Address - Country:US
Practice Address - Phone:401-475-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist