Healthcare Provider Details

I. General information

NPI: 1093123358
Provider Name (Legal Business Name): MARIE CARRERAS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE PEREZ DPT

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NORWOOD PARK S
NORWOOD MA
02062-4633
US

IV. Provider business mailing address

4 RICHMOND SQ STE 200
PROVIDENCE RI
02906-5117
US

V. Phone/Fax

Practice location:
  • Phone: 781-702-4630
  • Fax: 781-702-4510
Mailing address:
  • Phone: 401-433-4172
  • Fax: 401-433-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT011526
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL19709
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: