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NPI Code Detail

MEDICARE: JENNIFER LYNN PERREAULT

MEDICARE:   JENNIFER LYNN PERREAULT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation PhysicianPTA01203RI

General Provider Information

NPI Number : 1649840596
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNN PERREAULT
Provider Business Mailing Address
First Line : 44 CAPRON FARM DR
Second Line :
City : WARWICK
State : RI
Zip : 02886-7702
Country : US
Telephone Number : 979-299-9349
Fax Number :
Provider Business Practice Location Address
First Line : 15 SUMNER BROWN RD
Second Line :
City : CUMBERLAND
State : RI
Zip : 02864-1214
Country : US
Telephone Number : 401-333-6352
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2021
Last Update Date : 07/01/2021

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Directions to “ JENNIFER LYNN PERREAULT ” Practice Location

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