Healthcare Provider Details

I. General information

NPI: 1326371386
Provider Name (Legal Business Name): ZACHARY PEREIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 S MAIN ST
PROVIDENCE RI
02903-2910
US

IV. Provider business mailing address

10 RUTH AVE
RUMFORD RI
02916-3312
US

V. Phone/Fax

Practice location:
  • Phone: 508-675-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18734
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: