Healthcare Provider Details

I. General information

NPI: 1609486067
Provider Name (Legal Business Name): ELIZABETH PEREIRA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 GRANDE DR
PENSACOLA FL
32504-8965
US

IV. Provider business mailing address

2722 SANIBEL PL
GULF BREEZE FL
32563-5500
US

V. Phone/Fax

Practice location:
  • Phone: 850-746-4901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT34896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: