Healthcare Provider Details

I. General information

NPI: 1821669466
Provider Name (Legal Business Name): DANIELLE PINEAULT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 HIGHLAND AVE
FALL RIVER MA
02720-4305
US

IV. Provider business mailing address

2 HIGH ST
WESTPORT MA
02790-2427
US

V. Phone/Fax

Practice location:
  • Phone: 508-730-1070
  • Fax:
Mailing address:
  • Phone: 774-201-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8414
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: