Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Interventional and Functional Pain Center

Organization Physical Medicine & Rehabilitation Physician · NPI 1164907804

Interventional and Functional Pain Center is a Physical Medicine & Rehabilitation Physician in Cranston, Rhode Island. Registered with an NPI since 2018.

In the registry since
2018
Specialties on file
2

Practice location Address checks out

1150 Reservoir Ave Ste 200
Cranston, RI 02920-6043
Phone: (401) 648-6100
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Medicine & Rehabilitation Physician (primary) Taxonomy 208100000X
Physical Therapy Clinic/Center Taxonomy 261QP2000X

Record details

NPI number1164907804
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Juan Carlos Mirt — Office Manager · (401) 648-6100
NPI enumeratedSeptember 28, 2018
Last updated in NPPESJanuary 22, 2025
Certification dateJanuary 22, 2025
Mailing address1150 Reservoir Ave Ste 200, Cranston, RI 02920-6043

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