Healthcare Provider Details

I. General information

NPI: 1861267148
Provider Name (Legal Business Name): JOAO-PEDRO GUEDES PEREIRA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 NORTHERN BLVD STE 11
GREAT NECK NY
11021-4802
US

IV. Provider business mailing address

444 COMMUNITY DR STE 103-105
MANHASSET NY
11030-3803
US

V. Phone/Fax

Practice location:
  • Phone: 516-829-0030
  • Fax: 516-466-7723
Mailing address:
  • Phone: 516-365-3344
  • Fax: 516-365-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number051534
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: