Provider Demographics
NPI:1164139333
Name:SOARES, PETER A
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:SOARES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 FARRINGTON RD APT 209
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7011
Mailing Address - Country:US
Mailing Address - Phone:919-656-3376
Mailing Address - Fax:
Practice Address - Street 1:5760 FARRINGTON RD APT 209
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7011
Practice Address - Country:US
Practice Address - Phone:919-656-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist