Provider Demographics
NPI:1972257251
Name:PIERCE, PHILLIP (DPT)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:91 MAIN ST STE 122
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-4437
Practice Address - Country:US
Practice Address - Phone:401-289-2999
Practice Address - Fax:401-289-2950
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT.9967208100000X
RIPT03996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPT.9967OtherSOUTH CAROLINA DEPT OF LABOR, LICENSING, AND REGISTRATION BOARD OF PHYSICAL THER